MEDICARE: JENNY FUENTES DIAZ 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	2251X0800X	Orthopedic Physical Therapist	PT16655	FL

General Provider Information

NPI Number	:	1922366053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY FUENTES DIAZ PT

Provider Business Mailing Address
First Line	:	1876 SW 24TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-3834
Country	:	US
Telephone Number	:	305-281-0275
Fax Number	:

Provider Business Practice Location Address
First Line	:	1876 SW 24TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145-3834
Country	:	US
Telephone Number	:	305-281-0275
Fax Number	:

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

Provider Enumeration Date	:	04/26/2012
Last Update Date	:	03/03/2025

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