Provider Demographics
NPI:1154498335
Name:MAGILL, RITA NICKELS (PT, MSPT)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:NICKELS
Last Name:MAGILL
Suffix:
Gender:F
Credentials:PT, MSPT
Other - Prefix:
Other - First Name:RITA
Other - Middle Name:N
Other - Last Name:MAGILL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, MSPT
Mailing Address - Street 1:6280 SUNSET DR
Mailing Address - Street 2:SUITE 405
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4827
Mailing Address - Country:US
Mailing Address - Phone:305-662-4915
Mailing Address - Fax:561-883-6161
Practice Address - Street 1:6280 SUNSET DR
Practice Address - Street 2:SUITE 405
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4827
Practice Address - Country:US
Practice Address - Phone:305-662-4915
Practice Address - Fax:561-883-6161
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0007007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6387ZMedicare ID - Type Unspecified