Healthcare Provider Details

I. General information

NPI: 1891563243
Provider Name (Legal Business Name): LAVENDER PHYSICAL THERAPY & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2023
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 SW 22ND ST STE 404
MIAMI FL
33145-2657
US

IV. Provider business mailing address

9461 SW 119TH CT
MIAMI FL
33186-2007
US

V. Phone/Fax

Practice location:
  • Phone: 305-203-3074
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ERIKA LOPEZ
Title or Position: OWNER
Credential:
Phone: 305-203-3074