Healthcare Provider Details

I. General information

NPI: 1033706502
Provider Name (Legal Business Name): JANEL VALLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2020
Last Update Date: 12/30/2020
Certification Date: 12/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 CAMINO GARDENS BLVD STE 104
BOCA RATON FL
33432-5823
US

IV. Provider business mailing address

11710 NW 39TH ST
SUNRISE FL
33323-2631
US

V. Phone/Fax

Practice location:
  • Phone: 561-494-4499
  • Fax:
Mailing address:
  • Phone: 954-330-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA30596
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: