Healthcare Provider Details

I. General information

NPI: 1437752680
Provider Name (Legal Business Name): DEYRIS CORREA THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10951 SW 72ND TER
MIAMI FL
33173-2743
US

IV. Provider business mailing address

10951 SW 72ND TER
MIAMI FL
33173-2743
US

V. Phone/Fax

Practice location:
  • Phone: 786-291-2578
  • Fax:
Mailing address:
  • Phone: 786-291-2578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DEYRIS C CORREA FORTEZA
Title or Position: OWNER
Credential: OTR
Phone: 786-291-2578