Healthcare Provider Details

I. General information

NPI: 1679449516
Provider Name (Legal Business Name): DANIELA JAEL PENA PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 03/22/2026
Certification Date: 03/22/2026
Deactivation Date: 11/03/2025
Reactivation Date: 03/16/2026

III. Provider practice location address

930 SW 82ND AVE
MIAMI FL
33144-4240
US

IV. Provider business mailing address

14452 SW 38TH LN
MIAMI FL
33175-7830
US

V. Phone/Fax

Practice location:
  • Phone: 561-791-9090
  • Fax:
Mailing address:
  • Phone: 305-240-4797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT43194
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: