Provider Demographics
NPI:1508167933
Name:CARVAJAL, KAETHY (DPT)
Entity Type:Individual
Prefix:
First Name:KAETHY
Middle Name:
Last Name:CARVAJAL
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 1:11740 SW 107TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7800 NW 25TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122
Practice Address - Country:US
Practice Address - Phone:305-597-5468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24245225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist