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General NPI Number Information
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NPI Number | 1750177929
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Entity Type | Organization
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Legal Business Name | C&C PT LLC
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Dates
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Enumeration Date | 04/15/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 12030 SW 129TH CT STE 108
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City | MIAMI
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State | FL
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Zip | 33186-4584
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Country | US
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Telephone | 305-632-6393
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Fax |
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Provider Business Mailing Address
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Address Line | 12030 SW 129TH CT STE 108
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City | MIAMI
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State | FL
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Zip | 33186-4584
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JESSICA NOVOA
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Credential | DPT
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Telephone | 305-632-6393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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