Healthcare Provider Details

I. General information

NPI: 1427119015
Provider Name (Legal Business Name): MANOLO MOLINA B.S., PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 N KENDALL DR SUITE 102
MIAMI FL
33176-1978
US

IV. Provider business mailing address

1716 SW 13TH ST
MIAMI FL
33145-1402
US

V. Phone/Fax

Practice location:
  • Phone: 305-596-5458
  • Fax: 789-924-6336
Mailing address:
  • Phone: 305-860-5854
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT 18856
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: