=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275842817
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YESENIA URRUTIA LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2010
-----------------------------------------------------
Last Update Date | 09/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5901 SW 74TH ST
-----------------------------------------------------
City | SOUTH MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33143-5165
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-704-7910
-----------------------------------------------------
Fax | 305-235-8920
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15021 SW 180TERR
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33187
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-238-5931
-----------------------------------------------------
Fax | 305-238-5787
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------