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1306261938

NPI Code Detail

MEDICARE: IDIERYS MUSUMECI PT

MEDICARE: IDIERYS MUSUMECI PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT32956	FL

General Provider Information

NPI Number	:	1306261938
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IDIERYS MUSUMECI PT

Provider Business Mailing Address
First Line	:	17960 NW 13TH ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-3130
Country	:	US
Telephone Number	:	786-326-9953
Fax Number	:

Provider Business Practice Location Address
First Line	:	2564 W 72ND PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-6507
Country	:	US
Telephone Number	:	786-334-3125
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2014
Last Update Date	:	10/25/2021

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Directions to “ IDIERYS MUSUMECI PT” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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