Active NPI
Roberto Custodia Zantua III, PT
- Physical Therapist
- Oviedo, FL
National Provider Identifier
1124766274
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT4579
- Practice address
- Legacy Pointe at Ucf
2110 Hestia Loop
Oviedo, FL 32765 - Phone
- (407) 917-6418
- NPI assigned
- May 26, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT4579 | FL | Primary |
Addresses
Primary practice location
Legacy Pointe at Ucf
2110 Hestia Loop
Oviedo, FL 32765
Mailing address
Legacy Point at Ucf
2110 Hestia Loop
Oviedo, FL 34765
Phone (407) 917-6418
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT4579 | FL | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653523200000",
"number": "1124766274",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "LEGACY POINT AT UCF",
"address_2": "2110 HESTIA LOOP",
"city": "OVIEDO",
"state": "FL",
"postal_code": "34765",
"telephone_number": "407-917-6418"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "LEGACY POINTE AT UCF",
"address_2": "2110 HESTIA LOOP",
"city": "OVIEDO",
"state": "FL",
"postal_code": "32765",
"telephone_number": "407-917-6418"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZANTUA",
"first_name": "ROBERTO",
"middle_name": "CUSTODIA",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-05-26",
"last_updated": "2022-05-26",
"certification_date": "2022-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT4579",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oviedo, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.