Healthcare Provider Details

I. General information

NPI: 1780358556
Provider Name (Legal Business Name): PRESTIGIOUS THERAPY & WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 E 25TH ST STE 306
HIALEAH FL
33013-3849
US

IV. Provider business mailing address

777 E 25TH ST STE 306
HIALEAH FL
33013-3849
US

V. Phone/Fax

Practice location:
  • Phone: 305-497-2473
  • Fax: 213-426-8153
Mailing address:
  • Phone: 305-497-2473
  • Fax: 213-426-8153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: JESENIA VALDES
Title or Position: OWNER
Credential:
Phone: 305-497-2473