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General NPI Number Information
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NPI Number | 1972016657
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Entity Type | Individual
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Provider Name | AMADOR BUSUTIL VALDES PTA
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Gender | Male
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 7911 NW 72ND AVE STE 116A
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City | MEDLEY
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State | FL
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Zip | 33166-2222
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Country | US
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Telephone | 786-442-8923
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Fax |
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Provider Business Mailing Address
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Address Line | 12888 SW 151ST LN
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City | MIAMI
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State | FL
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Zip | 33186-6378
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Country | US
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Telephone | 786-442-8923
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA28128
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License Number State | FL
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