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General NPI Number Information
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NPI Number | 1801256102
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Entity Type | Organization
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Legal Business Name | MD THERAPY CENTER
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Dates
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Enumeration Date | 02/29/2016
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Last Update Date | 02/29/2016
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Provider Practice Location Address
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Address Line | 16239 NW 84TH AVE
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City | MIAMI LAKES
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State | FL
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Zip | 33016-6131
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Country | US
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Telephone | 917-664-2863
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Fax |
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Provider Business Mailing Address
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Address Line | 16239 NW 84TH AVE
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City | MIAMI LAKES
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State | FL
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Zip | 33016-6131
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Country | US
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Telephone | 917-664-2863
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MISS MAURY DIAZ
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Credential | MA,OTR/L
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Telephone | 917-664-2863
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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 | 16398
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 16398
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License Number State | FL
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