Provider Demographics
NPI:1235994518
Name:DOCMIALLC
Entity Type:Organization
Organization Name:DOCMIALLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CASERO
Authorized Official - Suffix:
Authorized Official - Credentials:MS, ATC, LAT
Authorized Official - Phone:305-527-6153
Mailing Address - Street 1:10420 W STATE ROAD 84 STE 4&5
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4266
Mailing Address - Country:US
Mailing Address - Phone:305-527-6153
Mailing Address - Fax:305-859-4578
Practice Address - Street 1:10420 W STATE ROAD 84 STE 4&5
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4266
Practice Address - Country:US
Practice Address - Phone:305-527-6153
Practice Address - Fax:305-859-4578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy