Provider Demographics
NPI:1518066901
Name:DEAZA, THOMAS (MSPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:DEAZA
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5760 SW 11TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5108
Mailing Address - Country:US
Mailing Address - Phone:305-215-8084
Mailing Address - Fax:305-260-9764
Practice Address - Street 1:11252 SW 152ND PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-4369
Practice Address - Country:US
Practice Address - Phone:305-388-7702
Practice Address - Fax:305-260-9764
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT-188302251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics