Healthcare Provider Details

I. General information

NPI: 1336557800
Provider Name (Legal Business Name): ARLANE VERGARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 SAWGRASS CORPORATE PKWY SUITE 100
SUNRISE FL
33323
US

IV. Provider business mailing address

1580 SAWGRASS CORPORATE PKWY SUITE 100
SUNRISE FL
33323
US

V. Phone/Fax

Practice location:
  • Phone: 954-739-4247
  • Fax:
Mailing address:
  • Phone: 954-739-4247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.020465
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number031850-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: