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General NPI Number Information
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NPI Number | 1760705909
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Entity Type | Individual
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Provider Name | LUIS ALONZO JR. OTR
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Gender | Male
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 03/22/2017
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Provider Practice Location Address
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Address Line | 9370 SW 72ND ST STE A212
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City | MIAMI
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State | FL
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Zip | 33173-5453
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Country | US
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Telephone | 786-401-6722
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Fax | 786-401-6041
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Provider Business Mailing Address
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Address Line | 18210 SW 112TH CT
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City | MIAMI
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State | FL
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Zip | 33157-4911
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Country | US
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Telephone | 305-316-4559
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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 | 225XP0019X
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Taxonomy Name | Physical Rehabilitation Occupational Therapist
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License Number | OT 12543
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License Number State | FL
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