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General NPI Number Information
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NPI Number | 1275148496
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Entity Type | Individual
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Provider Name | NICOLE S MAESTRI
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Gender | Female
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 03/02/2022
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Provider Practice Location Address
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Address Line | 15291 NW 60TH AVE STE 101
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2459
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Country | US
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Telephone | 305-705-7702
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Fax |
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Provider Business Mailing Address
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Address Line | 13950 MONTICELLO ST
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City | DAVIE
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State | FL
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Zip | 33325-1262
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Country | US
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Telephone | 305-439-0535
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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 | PT36015
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License Number State | FL
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