Healthcare Provider Details

I. General information

NPI: 1588203848
Provider Name (Legal Business Name): PIECE BY PIECE THERAPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2020
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 SW 72ND ST STE 499
MIAMI FL
33173-3022
US

IV. Provider business mailing address

10300 SW 72ND ST STE 499
MIAMI FL
33173-3022
US

V. Phone/Fax

Practice location:
  • Phone: 305-979-6178
  • Fax:
Mailing address:
  • Phone: 305-979-6178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: ALDO GUEVARA GONZALEZ
Title or Position: MANAGER
Credential: MD
Phone: 306-979-6178