Healthcare Provider Details

I. General information

NPI: 1184284960
Provider Name (Legal Business Name): STEFAN DANIEL VALDES DPT, SCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16200 NW 59TH AVE STE 107
MIAMI LAKES FL
33014-7541
US

IV. Provider business mailing address

8294 DUNDEE TER
MIAMI LAKES FL
33016-6418
US

V. Phone/Fax

Practice location:
  • Phone: 305-934-3506
  • Fax:
Mailing address:
  • Phone: 305-934-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT34805
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: