MEDICARE: MIA THERAPY PRO INC

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	261Q00000X	Clinic/Center

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	:	1417596818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIA THERAPY PRO INC

Provider Business Mailing Address
First Line	:	6165 SW 130TH AVE APT 1310
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-5234
Country	:	US
Telephone Number	:	786-370-8729
Fax Number	:	305-830-9043

Provider Business Practice Location Address
First Line	:	6165 SW 130TH AVE APT 1310
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33183-5234
Country	:	US
Telephone Number	:	786-370-8729
Fax Number	:	305-830-9043

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MAURICIO OSCAR GONZALEZ REYNALDO
Credential	:
Telephone Number	:	786-370-8729

Provider Enumeration Date	:	01/02/2020
Last Update Date	:	01/30/2025

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Directions to “MIA THERAPY PRO INC ” Practice Location

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