Provider Demographics
NPI:1730488578
Name:JEREZA, CLIFFORD BERNARD (PT)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:BERNARD
Last Name:JEREZA
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 1:1345 LINCOLN RD
Mailing Address - Street 2:APT 602
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-2210
Mailing Address - Country:US
Mailing Address - Phone:305-716-0976
Mailing Address - Fax:
Practice Address - Street 1:1345 LINCOLN RD
Practice Address - Street 2:APT 602
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-2210
Practice Address - Country:US
Practice Address - Phone:305-716-0976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist