Healthcare Provider Details

I. General information

NPI: 1982185625
Provider Name (Legal Business Name): TASHARAE YOLANDE WELSH PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2018
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5725 NW 186TH ST
HIALEAH FL
33015-6019
US

IV. Provider business mailing address

13786 SW 26TH ST
MIRAMAR FL
33027-3959
US

V. Phone/Fax

Practice location:
  • Phone: 305-625-9857
  • Fax:
Mailing address:
  • Phone: 817-313-3546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number24947
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: