Provider Demographics
NPI:1689938854
Name:MARIANO, AILEEN IRIS REYES (PT)
Entity Type:Individual
Prefix:
First Name:AILEEN IRIS
Middle Name:REYES
Last Name:MARIANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 SAWGRASS CORPORATE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2859
Mailing Address - Country:US
Mailing Address - Phone:954-332-4445
Mailing Address - Fax:866-422-6431
Practice Address - Street 1:1580 SAWGRASS CORPORATE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-2859
Practice Address - Country:US
Practice Address - Phone:954-332-4445
Practice Address - Fax:866-422-6431
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1215873225100000X
CT009312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist