Provider Demographics
NPI:1518414952
Name:VASQUEZ, JAIME (PTA)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5137 SW 183RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-6314
Mailing Address - Country:US
Mailing Address - Phone:754-244-5052
Mailing Address - Fax:954-342-0282
Practice Address - Street 1:5137 SW 183RD AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-6314
Practice Address - Country:US
Practice Address - Phone:754-244-5052
Practice Address - Fax:954-342-0282
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 21678225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant