MEDICARE: KARINA IGLESIAS PTA

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	225200000X	Physical Therapy Assistant	19620	FL

General Provider Information

NPI Number	:	1629195862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARINA IGLESIAS PTA

Provider Business Mailing Address
First Line	:	13084 SW 88TH LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-1606
Country	:	US
Telephone Number	:	786-443-4338
Fax Number	:

Provider Business Practice Location Address
First Line	:	13084 SW 88TH LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-1606
Country	:	US
Telephone Number	:	786-443-4338
Fax Number	:

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

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	07/08/2007

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