=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609572205
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CLAUDIA IGARZA PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2023
-----------------------------------------------------
Last Update Date | 02/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6901 YUMURI ST
-----------------------------------------------------
City | CORAL GABLES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33146-3607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-352-1391
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13715 SW 66TH ST APT 214
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33183-2399
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-352-1391
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | PTA25947
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------