Healthcare Provider Details

I. General information

NPI: 1093197048
Provider Name (Legal Business Name): STENDLEY AUGUSTE DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2015
Last Update Date: 06/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20295 NE 29TH PL STE 301
AVENTURA FL
33180-4109
US

IV. Provider business mailing address

1970 NE 159TH ST
NORTH MIAMI BEACH FL
33162-5750
US

V. Phone/Fax

Practice location:
  • Phone: 305-935-4551
  • Fax: 305-935-9274
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT30415
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: