Provider Demographics
NPI:1396043253
Name:COLLAZO, ARIADNA (DPT)
Entity Type:Individual
Prefix:DR
First Name:ARIADNA
Middle Name:
Last Name:COLLAZO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BAYVIEW DR APT 1610
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4759
Mailing Address - Country:US
Mailing Address - Phone:954-437-8099
Mailing Address - Fax:
Practice Address - Street 1:15346 NW 79TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-5850
Practice Address - Country:US
Practice Address - Phone:305-821-0502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL1212174400000X
FLPT27007225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist