Provider Demographics
NPI:1477083160
Name:PIQUE, HOMER BUSI
Entity Type:Individual
Prefix:
First Name:HOMER
Middle Name:BUSI
Last Name:PIQUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12272 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4227
Mailing Address - Country:US
Mailing Address - Phone:571-215-6850
Mailing Address - Fax:
Practice Address - Street 1:12272 WEST SAMPLE ROAD
Practice Address - Street 2:
Practice Address - City:CORAL SPRING
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:571-215-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2128459225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant