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General NPI Number Information
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NPI Number | 1114637337
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Entity Type | Individual
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Provider Name | THOMAS PELAEZ PT, DPT, CSCS
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Gender | Male
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 07/12/2023
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Provider Practice Location Address
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Address Line | 2001 NE 48TH ST
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City | FORT LAUDERDALE
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State | FL
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Zip | 33308-4517
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Country | US
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Telephone | 954-491-6620
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Fax |
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Provider Business Mailing Address
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Address Line | 118 N 32ND AVE
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City | HOLLYWOOD
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State | FL
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Zip | 33021-7020
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Country | US
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Telephone | 754-232-4909
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT39044
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License Number State | FL
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