Healthcare Provider Details

I. General information

NPI: 1780527069
Provider Name (Legal Business Name): FEDPRO PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3999 W 10TH CT
HIALEAH FL
33012-4184
US

IV. Provider business mailing address

3999 W 10TH CT
HIALEAH FL
33012-4184
US

V. Phone/Fax

Practice location:
  • Phone: 786-852-5204
  • Fax:
Mailing address:
  • Phone: 786-852-5204
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSE RODRIGUEZ
Title or Position: MANAGER
Credential:
Phone: 786-852-5204