Healthcare Provider Details

I. General information

NPI: 1154680411
Provider Name (Legal Business Name): SELECT PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2012
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 SW 137TH AVE
MIAMI FL
33175-6462
US

IV. Provider business mailing address

3808 SW 137TH AVE
MIAMI FL
33175-6462
US

V. Phone/Fax

Practice location:
  • Phone: 305-551-3338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT 26946
License Number StateFL

VIII. Authorized Official

Name: MRS. LOURDES JARAMILLO
Title or Position: MARKET MANAGER
Credential:
Phone: 305-769-8577