=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528817723
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BBHF LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2024
-----------------------------------------------------
Last Update Date | 05/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15373 CORTONA WAY
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34120-0675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-850-8625
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15373 CORTONA WAY
-----------------------------------------------------
City | NAPLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34120-0675
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-850-8625
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | DR. JULIO ALBERTO MAXIMILIANO DIAZ
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 239-850-8625
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------