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General NPI Number Information
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NPI Number | 1386364495
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Entity Type | Organization
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Legal Business Name | THIAGO QUEIROZ DO PA, LLC
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Dates
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Enumeration Date | 08/30/2022
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 3487 NW 30TH ST
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33311-1103
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Country | US
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Telephone | 205-835-4655
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Fax |
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Provider Business Mailing Address
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Address Line | 10741 SW 53RD ST
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City | COOPER CITY
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State | FL
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Zip | 33328-5639
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Country | US
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Telephone | 205-835-4655
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | THIAGO QUEIROZ
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Credential | DO
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Telephone | 205-835-4655
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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