Healthcare Provider Details

I. General information

NPI: 1194025189
Provider Name (Legal Business Name): HOLISTIC PHYSICAL THERAPY MIAMI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2010
Last Update Date: 10/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

472 NE 121ST ST
BISCAYNE PARK FL
33161-5439
US

IV. Provider business mailing address

472 NE 121ST ST
BISCAYNE PARK FL
33161-5439
US

V. Phone/Fax

Practice location:
  • Phone: 786-253-3829
  • Fax:
Mailing address:
  • Phone: 786-253-3829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: ADRIANA M PEREZ
Title or Position: MANAGER MEMBER
Credential:
Phone: 786-253-3829