Provider Demographics
NPI:1508524927
Name:MONTALVO, CHARLENE L (PT DPT)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:L
Last Name:MONTALVO
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6280 SUNSET DR STE 405
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4860
Mailing Address - Country:US
Mailing Address - Phone:305-662-4915
Mailing Address - Fax:305-662-8746
Practice Address - Street 1:6280 SUNSET DR STE 405
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4860
Practice Address - Country:US
Practice Address - Phone:305-662-4915
Practice Address - Fax:305-662-8746
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT38094225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty