Provider Demographics
NPI:1619221157
Name:BAROUCHE, DAVID (PT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:BAROUCHE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ARTHUR GODFREY RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3637
Mailing Address - Country:US
Mailing Address - Phone:305-672-0614
Mailing Address - Fax:305-612-0918
Practice Address - Street 1:300 ARTHUR GODFREY RD
Practice Address - Street 2:SUITE 205
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3637
Practice Address - Country:US
Practice Address - Phone:305-672-0614
Practice Address - Fax:305-612-0918
Is Sole Proprietor?:No
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27881174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist