MEDICARE: MS. DAPHNE EILEEN ARDIZON 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	PT23296	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346441037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAPHNE EILEEN ARDIZON PT

Provider Business Mailing Address
First Line	:	3754 SW 156TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4801
Country	:	US
Telephone Number	:	305-553-0585
Fax Number	:

Provider Business Practice Location Address
First Line	:	2619 SW 147TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5622
Country	:	US
Telephone Number	:	305-207-0602
Fax Number	:

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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