Healthcare Provider Details

I. General information

NPI: 1417668708
Provider Name (Legal Business Name): AUGUSTO ANDRES INCER PT DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2022
Last Update Date: 12/08/2022
Certification Date: 12/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8603 S DIXIE HWY STE 308
PINECREST FL
33156-1129
US

IV. Provider business mailing address

8603 S DIXIE HWY STE 308
PINECREST FL
33156-1129
US

V. Phone/Fax

Practice location:
  • Phone: 305-661-1441
  • Fax: 305-661-1443
Mailing address:
  • Phone: 305-661-1441
  • Fax: 305-661-1443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT39599
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: