Provider Demographics
NPI:1477663367
Name:VINALS, JORGE E (PT, ATC, CMT, CSCS)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:E
Last Name:VINALS
Suffix:
Gender:M
Credentials:PT, ATC, CMT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3341 SW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1821
Mailing Address - Country:US
Mailing Address - Phone:305-342-4270
Mailing Address - Fax:305-567-1570
Practice Address - Street 1:3341 SW 17TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-1821
Practice Address - Country:US
Practice Address - Phone:305-342-4270
Practice Address - Fax:305-567-1570
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 22557225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT22557OtherLICENSE#