Healthcare Provider Details

I. General information

NPI: 1164239406
Provider Name (Legal Business Name): KARINA NICOLE CISNEROS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2024
Last Update Date: 12/11/2024
Certification Date: 12/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10570 SW 8TH ST
MIAMI FL
33174-2612
US

IV. Provider business mailing address

12927 SW 151ST LN
MIAMI FL
33186-7608
US

V. Phone/Fax

Practice location:
  • Phone: 305-222-1892
  • Fax:
Mailing address:
  • Phone: 786-972-6224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT42472
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: