Healthcare Provider Details

I. General information

NPI: 1902174709
Provider Name (Legal Business Name): DELGARRO PHYSICAL THERAPY CENTER, CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 12/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 NW 95TH ST APT 228
HIALEAH GARDENS FL
33016-2361
US

IV. Provider business mailing address

8040 NW 95TH ST APT 228
HIALEAH GARDENS FL
33016-2361
US

V. Phone/Fax

Practice location:
  • Phone: 305-819-1095
  • Fax: 305-819-1094
Mailing address:
  • Phone: 305-819-1095
  • Fax: 305-819-1094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA62214
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberMM28078
License Number StateFL

VIII. Authorized Official

Name: MRS. ANNELIS GARROTE
Title or Position: OWNER
Credential: LMT
Phone: 786-712-7096