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General NPI Number Information
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NPI Number | 1790376796
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Entity Type | Organization
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Legal Business Name | MISSION PT, LLC
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Dates
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Enumeration Date | 02/01/2021
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 7700 N KENDALL DR STE 507
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City | MIAMI
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State | FL
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Zip | 33156-7566
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Country | US
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Telephone | 786-517-7998
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Fax |
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Provider Business Mailing Address
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Address Line | 9200 SW 153RD PSGE
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City | MIAMI
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State | FL
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Zip | 33196-2842
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Country | US
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Telephone | 786-517-7998
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | DANIEL VILLALTA
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Credential | MPT
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Telephone | 786-517-7998
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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