Provider Demographics
NPI:1740406578
Name:PAZ SOLDAN, LUIS M (PT)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:M
Last Name:PAZ SOLDAN
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 1:2836 SW 195TH TERRACE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2472
Mailing Address - Country:US
Mailing Address - Phone:305-206-8146
Mailing Address - Fax:
Practice Address - Street 1:2836 SW 195TH TER
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-2472
Practice Address - Country:US
Practice Address - Phone:305-206-8146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 14621225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT14621Medicaid