Provider Demographics
NPI:1508178146
Name:NARVAEZ, ROSE MARY (PTA)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:MARY
Last Name:NARVAEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14291 SW 120TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7287
Mailing Address - Country:US
Mailing Address - Phone:305-385-0168
Mailing Address - Fax:305-385-0182
Practice Address - Street 1:14291 SW 120TH ST STE 103
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7287
Practice Address - Country:US
Practice Address - Phone:305-385-0168
Practice Address - Fax:305-385-0182
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 18492225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant