Healthcare Provider Details

I. General information

NPI: 1023991726
Provider Name (Legal Business Name): K'WAN JABARI GRICE PT,DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17601 NW 2ND AVE
MIAMI FL
33169-5001
US

IV. Provider business mailing address

14170 NW 17TH AVE
OPA LOCKA FL
33054-2180
US

V. Phone/Fax

Practice location:
  • Phone: 305-770-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: