Provider Demographics
NPI:1619216561
Name:CASTROVIEJO, LAURA FERNANDA
Entity Type:Individual
Prefix:PROF
First Name:LAURA
Middle Name:FERNANDA
Last Name:CASTROVIEJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13349 SW 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6544
Mailing Address - Country:US
Mailing Address - Phone:786-201-1703
Mailing Address - Fax:786-573-3619
Practice Address - Street 1:13349 SW 122ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6544
Practice Address - Country:US
Practice Address - Phone:786-201-1703
Practice Address - Fax:786-573-3619
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20858225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist