Provider Demographics
NPI:1255838231
Name:CAMACHO-MONTALVO, BETTY PATRICIA (PT)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:PATRICIA
Last Name:CAMACHO-MONTALVO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18561 SW 52ND ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-6250
Mailing Address - Country:US
Mailing Address - Phone:954-494-6272
Mailing Address - Fax:
Practice Address - Street 1:18561 SW 52ND ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-6250
Practice Address - Country:US
Practice Address - Phone:954-494-6272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-06
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9357225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist