Healthcare Provider Details

I. General information

NPI: 1821491390
Provider Name (Legal Business Name): FISIO&QUALITY MIAMI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 MIRACLE MILE SUITE 209
CORAL GABLES FL
33134-5910
US

IV. Provider business mailing address

220 MIRACLE MILE SUITE 209
CORAL GABLES FL
33134-5910
US

V. Phone/Fax

Practice location:
  • Phone: 305-476-3646
  • Fax:
Mailing address:
  • Phone: 305-476-3646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: GUSTAVO BERTOLINO
Title or Position: DIRECTOR CEO
Credential:
Phone: 305-476-3646