Healthcare Provider Details

I. General information

NPI: 1275915340
Provider Name (Legal Business Name): BEATRIZ SAGARDUY GRIMAL DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BEATRIZ SAGARDUY SUSTACHA DPT

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11205 S DIXIE HWY STE 101
PINECREST FL
33156-4447
US

IV. Provider business mailing address

11205 S DIXIE HWY STE 101
PINECREST FL
33156-4447
US

V. Phone/Fax

Practice location:
  • Phone: 786-250-4653
  • Fax: 786-321-5441
Mailing address:
  • Phone: 786-250-4653
  • Fax: 786-321-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number30453
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: