Healthcare Provider Details

I. General information

NPI: 1508780610
Provider Name (Legal Business Name): RAFAEL ANTONIO AGUILAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 S MIAMI AVE
MIAMI FL
33133-4253
US

IV. Provider business mailing address

8758 CANOPY OAKS DR
JACKSONVILLE FL
32256-9089
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-4400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT45163
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: