MEDICARE: MR. JOSE CINTRON BURGOS MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT30329	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT30329	OTHER	FL	FL DOH

General Provider Information

NPI Number	:	1407192933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSE CINTRON BURGOS MSPT

Provider Business Mailing Address
First Line	:	8040 NW 95TH ST
Second Line	:	STE 223-224
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-2362
Country	:	US
Telephone Number	:	941-587-9386
Fax Number	:	305-675-7929

Provider Business Practice Location Address
First Line	:	8040 NW 95TH ST STE 223-224
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33016-2362
Country	:	US
Telephone Number	:	941-587-9386
Fax Number	:	941-587-9386

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2013
Last Update Date	:	07/21/2022

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