Healthcare Provider Details

I. General information

NPI: 1962011221
Provider Name (Legal Business Name): PINECREST STRENGTH & CONDITIONING, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 07/23/2020
Certification Date: 07/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7040 SW 44TH ST
MIAMI FL
33155-4609
US

IV. Provider business mailing address

PO BOX 331941
MIAMI FL
33233-1941
US

V. Phone/Fax

Practice location:
  • Phone: 305-722-0568
  • Fax: 305-670-0899
Mailing address:
  • Phone: 305-722-0568
  • Fax: 306-670-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD RANI YACOUB
Title or Position: OWNER
Credential: MSPT
Phone: 305-722-0568