Healthcare Provider Details

I. General information

NPI: 1770861312
Provider Name (Legal Business Name): UCHA C UKPAI DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9850 STIRLING RD STE 100
HOLLYWOOD FL
33024-8068
US

IV. Provider business mailing address

5837 NW 56TH DR
CORAL SPRINGS FL
33067-3542
US

V. Phone/Fax

Practice location:
  • Phone: 954-709-1192
  • Fax:
Mailing address:
  • Phone: 954-736-7427
  • Fax: 954-706-1192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number28979
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT28979
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: