Provider Demographics
NPI:1982445359
Name:BAUTISTA ENCISO, IVONNE S
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:S
Last Name:BAUTISTA ENCISO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2829 NW 110TH TER
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33322-1853
Mailing Address - Country:US
Mailing Address - Phone:772-333-9808
Mailing Address - Fax:
Practice Address - Street 1:12220 SW 188TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-3120
Practice Address - Country:US
Practice Address - Phone:786-380-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-01
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41653225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist