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General NPI Number Information
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NPI Number | 1245715762
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Entity Type | Individual
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Provider Name | MRS. BARBARA EDEN DE OLIVEIRA SA LATYKI
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Gender | Female
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Dates
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Enumeration Date | 10/01/2018
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Last Update Date | 12/16/2019
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Provider Practice Location Address
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Address Line | 7033 COMMONWEALTH AVE STE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32220-2831
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Country | US
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Telephone | 904-378-3202
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Fax |
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Provider Business Mailing Address
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Address Line | 216 BERGEN ST APT 2
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City | HARRISON
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State | NJ
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Zip | 07029-2112
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Country | US
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Telephone | 862-242-6039
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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 | 40QA01806500
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT35095
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License Number State | FL
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