Healthcare Provider Details

I. General information

NPI: 1154638120
Provider Name (Legal Business Name): EMMA VEGA GARRIGA MSPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2010
Last Update Date: 09/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 SW 103RD PL
MIAMI FL
33165-6244
US

IV. Provider business mailing address

5120 SW 103RD PL
MIAMI FL
33165-6244
US

V. Phone/Fax

Practice location:
  • Phone: 305-275-5890
  • Fax:
Mailing address:
  • Phone: 305-275-5890
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number18216
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: