Healthcare Provider Details

I. General information

NPI: 1104025527
Provider Name (Legal Business Name): MARCELA PERAZA, MPT, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2007
Last Update Date: 02/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2734 JACKSON ST
HOLLYWOOD FL
33020-4812
US

IV. Provider business mailing address

2734 JACKSON ST
HOLLYWOOD FL
33020-4812
US

V. Phone/Fax

Practice location:
  • Phone: 305-987-7803
  • Fax:
Mailing address:
  • Phone: 305-987-7803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT20392
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberPT20392
License Number StateFL

VIII. Authorized Official

Name: MARCELA MARIA PERAZA
Title or Position: PRESIDENT/OWNER
Credential: MPT
Phone: 305-987-7803