Healthcare Provider Details

I. General information

NPI: 1700488616
Provider Name (Legal Business Name): MARIO ALBERTO ESPINOSA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2020
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date: 07/31/2023
Reactivation Date: 08/28/2023

III. Provider practice location address

10650 W STATE ROAD 84
DAVIE FL
33324-4235
US

IV. Provider business mailing address

13841 SW 106 ST
MIAMI FL
33188-6651
US

V. Phone/Fax

Practice location:
  • Phone: 754-273-8106
  • Fax:
Mailing address:
  • Phone: 754-273-8106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number36236
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: