Provider Demographics
NPI:1003274606
Name:LIEBMAN, MIRIT HAZAN
Entity Type:Individual
Prefix:
First Name:MIRIT
Middle Name:HAZAN
Last Name:LIEBMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 S UNIVERSITY DR STE 603
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5314
Mailing Address - Country:US
Mailing Address - Phone:954-900-2942
Mailing Address - Fax:954-451-3948
Practice Address - Street 1:5400 S UNIVERSITY DR STE 603
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5314
Practice Address - Country:US
Practice Address - Phone:954-900-2942
Practice Address - Fax:954-451-3948
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT30064225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist