Healthcare Provider Details

I. General information

NPI: 1861273336
Provider Name (Legal Business Name): TARYN NICHOLE PARK PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 NE 25TH ST STE 103
MIAMI FL
33137-4852
US

IV. Provider business mailing address

500 BRICKELL AVE APT 3803
MIAMI FL
33131-2589
US

V. Phone/Fax

Practice location:
  • Phone: 305-735-8901
  • Fax:
Mailing address:
  • Phone: 480-278-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: