Healthcare Provider Details

I. General information

NPI: 1740546514
Provider Name (Legal Business Name): FLORIDA ORTHOPAEDIC INSTITUTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 04/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 SW 87TH CT SUITE 209
MIAMI FL
33176-2231
US

IV. Provider business mailing address

7860 SW 129TH TER
PINECREST FL
33156-6154
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-3311
  • Fax: 305-274-1411
Mailing address:
  • Phone: 305-274-3311
  • Fax: 305-274-1411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberPT16622
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT16622
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT16622
License Number StateFL

VIII. Authorized Official

Name: SUSANA VERONICA PEREDA
Title or Position: PRESIDENT
Credential:
Phone: 305-274-3311