Healthcare Provider Details

I. General information

NPI: 1447950704
Provider Name (Legal Business Name): MIRIAM ESTHER HABAN P.T.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 09/29/2026
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5471 W WATERS AVE STE 103
TAMPA FL
33634-1257
US

IV. Provider business mailing address

5471 W WATERS AVE STE 103
TAMPA FL
33634-1257
US

V. Phone/Fax

Practice location:
  • Phone: 813-328-4120
  • Fax:
Mailing address:
  • Phone: 813-328-4120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number29876
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA76687
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: