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General NPI Number Information
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NPI Number | 1275354953
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Entity Type | Organization
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Legal Business Name | NEW IMAGE THERAPY CORP
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 15271 NW 60TH AVE STE 101
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2431
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Country | US
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Telephone | 786-398-1892
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Fax |
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Provider Business Mailing Address
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Address Line | 15271 NW 60TH AVE STE 101
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2431
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Country | US
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Telephone | 786-398-1892
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Fax |
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Authorized Official
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Title or Position | CONSULTANY
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Name | AMADOR REYES
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Credential | AUTHORIZED DELEGATE
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Telephone | 786-253-7699
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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