Healthcare Provider Details

I. General information

NPI: 1205790730
Provider Name (Legal Business Name): PEDRO OLIVEIRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 GRANELLO AVE
CORAL GABLES FL
33146-1883
US

IV. Provider business mailing address

21150 BISCAYNE BLVD STE 406
AVENTURA FL
33180-1250
US

V. Phone/Fax

Practice location:
  • Phone: 305-420-5682
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT44055
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: