Healthcare Provider Details

I. General information

NPI: 1053925230
Provider Name (Legal Business Name): RAQUEL CASTRO ANDRADE DA COSTA RANGEL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3994 W HILLSBORO BLVD # 33442
DEERFIELD BEACH FL
33442-9416
US

IV. Provider business mailing address

6909 TOWN HARBOUR BLVD APT 911
BOCA RATON FL
33433-4325
US

V. Phone/Fax

Practice location:
  • Phone: 954-360-7779
  • Fax:
Mailing address:
  • Phone: 561-809-6709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT35742
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: