Healthcare Provider Details

I. General information

NPI: 1710286802
Provider Name (Legal Business Name): KIMBERLY WESTERFIELD PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3412 W 84TH ST
HIALEAH FL
33018-4918
US

IV. Provider business mailing address

3412 W 84TH ST
HIALEAH FL
33018-4918
US

V. Phone/Fax

Practice location:
  • Phone: 305-827-7344
  • Fax:
Mailing address:
  • Phone: 305-827-7344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA20211
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: