Provider Demographics
NPI:1093995169
Name:SHABANI, MARIE MELISSA (MSPT)
Entity Type:Individual
Prefix:MS
First Name:MARIE
Middle Name:MELISSA
Last Name:SHABANI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4284 SW 161ST PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-3826
Mailing Address - Country:US
Mailing Address - Phone:305-228-6252
Mailing Address - Fax:305-228-6251
Practice Address - Street 1:4284 SW 161ST PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-3826
Practice Address - Country:US
Practice Address - Phone:305-228-6252
Practice Address - Fax:305-228-6251
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22463225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist