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General NPI Number Information
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NPI Number | 1700017381
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Entity Type | Individual
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Provider Name | HUGO A LARA SR. PHYSICAL THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 07/30/2009
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Last Update Date | 08/19/2022
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Provider Practice Location Address
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Address Line | 10031 PINES BLVD STE 105
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-6185
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Country | US
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Telephone | 954-431-4245
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Fax |
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Provider Business Mailing Address
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Address Line | 6300 SW 89TH CT
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City | MIAMI
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State | FL
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Zip | 33173-2413
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Country | US
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Telephone | 305-877-4348
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 22759
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 22759
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License Number State | FL
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