Healthcare Provider Details

I. General information

NPI: 1326696279
Provider Name (Legal Business Name): BEAUTIFUL MINDS PPEC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2019
Last Update Date: 09/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 W PALM DR
FLORIDA CITY FL
33034-3208
US

IV. Provider business mailing address

23846 SW 116TH CT
HOMESTEAD FL
33032-7188
US

V. Phone/Fax

Practice location:
  • Phone: 305-647-9499
  • Fax: 305-508-6440
Mailing address:
  • Phone: 305-647-9499
  • Fax: 305-508-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: GABRIELA MARINELLO
Title or Position: DIRECTOR
Credential:
Phone: 305-647-9499