Provider Demographics
NPI:1659781821
Name:LLANOS, CARLOS (PTA)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:LLANOS
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 1:13951 SW 66TH ST APT 306A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-1850
Mailing Address - Country:US
Mailing Address - Phone:786-295-0155
Mailing Address - Fax:
Practice Address - Street 1:13951 SW 66TH ST APT 306A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-1850
Practice Address - Country:US
Practice Address - Phone:786-295-0155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA21676208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation