Healthcare Provider Details

I. General information

NPI: 1407284086
Provider Name (Legal Business Name): JAGUAR PT SOUTH BEACH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 10/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 23RD ST SUITE 200
MIAMI BEACH FL
33139-1721
US

IV. Provider business mailing address

309 23RD ST SUITE 200
MIAMI BEACH FL
33139-1721
US

V. Phone/Fax

Practice location:
  • Phone: 305-935-9599
  • Fax:
Mailing address:
  • Phone:
  • 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: MATTHEW COOPER
Title or Position: DC
Credential:
Phone: 305-935-9599