MEDICARE: MIRIAM MARIE GUANCHE 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	PT19319	FL

General Provider Information

NPI Number	:	1356489223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM MARIE GUANCHE PT

Provider Business Mailing Address
First Line	:	2931 CORAL WAY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-3205
Country	:	US
Telephone Number	:	305-444-0074
Fax Number	:	305-444-8503

Provider Business Practice Location Address
First Line	:	2931 CORAL WAY
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-3205
Country	:	US
Telephone Number	:	305-444-0074
Fax Number	:	305-444-8503

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	03/11/2020

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Directions to “ MIRIAM MARIE GUANCHE PT” Practice Location

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