Provider Demographics
NPI:1346778313
Name:FAVILLA, PAULA PRIETO (PT)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:PRIETO
Last Name:FAVILLA
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 1:6551 NW 98TH DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-2325
Mailing Address - Country:US
Mailing Address - Phone:954-470-1743
Mailing Address - Fax:
Practice Address - Street 1:6551 NW 98TH DR
Practice Address - Street 2:
Practice Address - City:PARKLAND
Practice Address - State:FL
Practice Address - Zip Code:33076-2325
Practice Address - Country:US
Practice Address - Phone:954-470-1743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2022-07-21
Deactivation Date:2018-11-09
Deactivation Code:
Reactivation Date:2021-04-07
Provider Licenses
StateLicense IDTaxonomies
FL32454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist