Healthcare Provider Details

I. General information

NPI: 1740658210
Provider Name (Legal Business Name): JUAN ALEMAN PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 W 51ST PL
HIALEAH FL
33012-3620
US

IV. Provider business mailing address

456 W 51ST PL
HIALEAH FL
33012-3620
US

V. Phone/Fax

Practice location:
  • Phone: 305-364-0337
  • Fax: 305-364-0338
Mailing address:
  • Phone: 305-364-0337
  • Fax: 305-364-0338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA11955
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: