Healthcare Provider Details

I. General information

NPI: 1598308769
Provider Name (Legal Business Name): NATHERCIA NAYARA ROCHA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2019
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8415 SW 24TH ST STE 205
MIAMI FL
33155-2305
US

IV. Provider business mailing address

12935 SW 133RD TER
MIAMI FL
33186-6906
US

V. Phone/Fax

Practice location:
  • Phone: 305-262-6868
  • Fax:
Mailing address:
  • Phone: 305-491-9709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT35775
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: