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General NPI Number Information
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NPI Number | 1861273336
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Entity Type | Individual
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Provider Name | TARYN NICHOLE PARK PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 10/11/2023
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Last Update Date | 10/11/2023
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Provider Practice Location Address
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Address Line | 162 NE 25TH ST STE 103
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City | MIAMI
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State | FL
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Zip | 33137-4852
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Country | US
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Telephone | 305-735-8901
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Fax |
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Provider Business Mailing Address
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Address Line | 500 BRICKELL AVE APT 3803
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City | MIAMI
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State | FL
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Zip | 33131-2589
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Country | US
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Telephone | 480-278-5311
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 39092
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License Number State | FL
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