Healthcare Provider Details

I. General information

NPI: 1609569219
Provider Name (Legal Business Name): ERDNA ISABELLE BARBANCOURT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S CYPRESS RD
POMPANO BEACH FL
33060-7133
US

IV. Provider business mailing address

5220 SW 30TH AVE
FORT LAUDERDALE FL
33312-6907
US

V. Phone/Fax

Practice location:
  • Phone: 954-781-7248
  • Fax:
Mailing address:
  • Phone: 954-478-6030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPTT40245
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTT40245
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: