Provider Demographics
NPI:1174007983
Name:IWABUCHI, MISA (DPT)
Entity Type:Individual
Prefix:
First Name:MISA
Middle Name:
Last Name:IWABUCHI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 NE 1ST AVE APT 901
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4083
Mailing Address - Country:US
Mailing Address - Phone:248-808-4760
Mailing Address - Fax:
Practice Address - Street 1:1040 71ST ST STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-2978
Practice Address - Country:US
Practice Address - Phone:305-868-9905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist