Healthcare Provider Details

I. General information

NPI: 1427860519
Provider Name (Legal Business Name): DORAL PHYSIOTHERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2025
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 NW 82ND AVE STE 105
DORAL FL
33166-6662
US

IV. Provider business mailing address

3650 NW 82ND AVE STE 103
DORAL FL
33166-6662
US

V. Phone/Fax

Practice location:
  • Phone: 305-227-4263
  • Fax: 305-537-7222
Mailing address:
  • Phone: 305-227-4263
  • Fax: 305-537-7222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELVIA REYES
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 305-227-4263