Healthcare Provider Details

I. General information

NPI: 1841916426
Provider Name (Legal Business Name): DEYRIS CORREA THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2022
Last Update Date: 10/17/2022
Certification Date: 10/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10951 SW 72ND TER
MIAMI FL
33173-2743
US

IV. Provider business mailing address

10951 SW 72ND TER
MIAMI FL
33173-2743
US

V. Phone/Fax

Practice location:
  • Phone: 786-291-2578
  • Fax:
Mailing address:
  • Phone: 786-291-2578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name: DEYRIS CORREA FORTEZA
Title or Position: OWNER
Credential: OT
Phone: 786-291-2578