Provider Demographics
NPI:1437102134
Name:AVILES, NELSON MANUEL (MSPT)
Entity Type:Individual
Prefix:
First Name:NELSON
Middle Name:MANUEL
Last Name:AVILES
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21830 SW 98TH AVE
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1183
Mailing Address - Country:US
Mailing Address - Phone:305-975-0716
Mailing Address - Fax:305-975-0716
Practice Address - Street 1:21830 SW 98TH AVE
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1183
Practice Address - Country:US
Practice Address - Phone:305-975-0716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17995225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00393900Medicaid