Provider Demographics
NPI:1760705909
Name:ALONZO, LUIS JR (OTR)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
Last Name:ALONZO
Suffix:JR
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18210 SW 112TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4911
Mailing Address - Country:US
Mailing Address - Phone:305-316-4559
Mailing Address - Fax:
Practice Address - Street 1:9370 SW 72ND ST STE A212
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-5453
Practice Address - Country:US
Practice Address - Phone:786-401-6722
Practice Address - Fax:786-401-6041
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-02
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 12543225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation