Provider Demographics
NPI:1386179919
Name:CONCEPCION, JANDRY (DPT)
Entity Type:Individual
Prefix:DR
First Name:JANDRY
Middle Name:
Last Name:CONCEPCION
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13917 SW 90TH AVE APT B113
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-6963
Mailing Address - Country:US
Mailing Address - Phone:305-721-9954
Mailing Address - Fax:
Practice Address - Street 1:7791 NW 46TH ST STE 210
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-5482
Practice Address - Country:US
Practice Address - Phone:305-878-0083
Practice Address - Fax:305-821-2848
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2021-05-26
Deactivation Date:2020-08-19
Deactivation Code:
Reactivation Date:2021-05-24
Provider Licenses
StateLicense IDTaxonomies
FLPT36111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist