Healthcare Provider Details

I. General information

NPI: 1821891797
Provider Name (Legal Business Name): MISAEL ESPINOSA PTA, BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5757 WATERFORD DISTRICT DR
MIAMI FL
33126-2058
US

IV. Provider business mailing address

7815 CAMINO REAL # I-315
MIAMI FL
33143-6874
US

V. Phone/Fax

Practice location:
  • Phone: 305-860-7797
  • Fax:
Mailing address:
  • Phone: 786-319-0725
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number33467
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: