Healthcare Provider Details

I. General information

NPI: 1962317800
Provider Name (Legal Business Name): DR. PENELOPE REGALADO, DPT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 NE 211TH TER
MIAMI FL
33179-1335
US

IV. Provider business mailing address

1350 NE 211TH TER
MIAMI FL
33179-1335
US

V. Phone/Fax

Practice location:
  • Phone: 561-591-9776
  • Fax:
Mailing address:
  • Phone: 561-591-9776
  • Fax:

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: PENELOPE REGALADO
Title or Position: MANAGER
Credential: DPT
Phone: 305-498-7664