=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457594293
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAZOLI ENTERPRISES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2009
-----------------------------------------------------
Last Update Date | 06/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2780 SW 87TH AVE SUITE 110
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-3296
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-553-0104
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2780 SW 87TH AVE SUITE 110
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-3296
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-553-0104
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER
-----------------------------------------------------
Name | MRS. EMMA GALTES
-----------------------------------------------------
Credential | OTR
-----------------------------------------------------
Telephone | 78655530104
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | PT 10913
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT 6399
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------