Healthcare Provider Details

I. General information

NPI: 1831016708
Provider Name (Legal Business Name): PREMIERE PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 NW 79TH ST STE 104
MIAMI FL
33150-3141
US

IV. Provider business mailing address

1005 NW 79TH ST STE 104
MIAMI FL
33150-3141
US

V. Phone/Fax

Practice location:
  • Phone: 305-756-9947
  • Fax: 305-756-9948
Mailing address:
  • Phone: 305-756-9947
  • Fax: 305-756-9948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MISS ROOSEVELT MOORE
Title or Position: MANAGER
Credential: DPT
Phone: 305-968-5622