Healthcare Provider Details

I. General information

NPI: 1154977361
Provider Name (Legal Business Name): ERIC HAVEY PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3183 SW 38TH CT
MIAMI FL
33146-1528
US

IV. Provider business mailing address

425 NE 22ND ST APT 609
MIAMI FL
33137-5183
US

V. Phone/Fax

Practice location:
  • Phone: 305-501-0231
  • Fax:
Mailing address:
  • Phone: 712-541-1890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT34956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: