Healthcare Provider Details

I. General information

NPI: 1083889059
Provider Name (Legal Business Name): PHYSICAL THERAPY AT DORAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 NW 18TH TERRACE SUITE 211
DORAL FL
33172-2697
US

IV. Provider business mailing address

8725 NW 18TH TERRACE SUITE 211
DORAL FL
33172-2697
US

V. Phone/Fax

Practice location:
  • Phone: 305-537-7227
  • Fax: 305-537-7224
Mailing address:
  • Phone: 305-537-7227
  • Fax: 305-537-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL R DE CARDENAS
Title or Position: CEO
Credential:
Phone: 305-537-7227