Provider Demographics
NPI:1760653661
Name:BARDITCH, GASPARA (MSPT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:GASPARA
Middle Name:
Last Name:BARDITCH
Suffix:
Gender:F
Credentials:MSPT, DPT
Other - Prefix:MISS
Other - First Name:GASPARA
Other - Middle Name:
Other - Last Name:MIRANDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:11223 SW 134TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-5337
Mailing Address - Country:US
Mailing Address - Phone:786-399-8328
Mailing Address - Fax:
Practice Address - Street 1:11223 SW 134TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-5337
Practice Address - Country:US
Practice Address - Phone:786-399-8328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist