Provider Demographics
NPI:1811403728
Name:FERRERO, MARCOS A
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:A
Last Name:FERRERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15915 NW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6703
Mailing Address - Country:US
Mailing Address - Phone:786-613-7160
Mailing Address - Fax:786-613-7161
Practice Address - Street 1:15915 NW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6703
Practice Address - Country:US
Practice Address - Phone:786-613-7160
Practice Address - Fax:786-613-7161
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-15
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA24494225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty