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General NPI Number Information
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NPI Number | 1124425665
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Entity Type | Organization
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Legal Business Name | STINKY FEET LLC
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Dates
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Enumeration Date | 11/27/2014
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Last Update Date | 11/27/2014
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Provider Practice Location Address
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Address Line | 4101 PINE TREE DR 1731
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City | MIAMI BEACH
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State | FL
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Zip | 33140-3628
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Country | US
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Telephone | 305-934-3698
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Fax |
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Provider Business Mailing Address
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Address Line | 4101 PINE TREE DR 1731
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City | MIAMI BEACH
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State | FL
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Zip | 33140-3628
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Country | US
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Telephone | 305-934-3698
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DAVID BAROUCHE
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Credential | P.T.
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Telephone | 305-934-3698
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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 | PT27881
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License Number State | FL
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