Provider Demographics
NPI:1346477908
Name:BRAVO, PATRICIA R (PT)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:R
Last Name:BRAVO
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 1:13335 SW 124TH ST
Mailing Address - Street 2:102
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6418
Mailing Address - Country:US
Mailing Address - Phone:305-378-5247
Mailing Address - Fax:
Practice Address - Street 1:13335 SW 124TH ST
Practice Address - Street 2:102
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6418
Practice Address - Country:US
Practice Address - Phone:305-378-5247
Practice Address - Fax:305-378-6736
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT15230225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist