Provider Demographics
NPI:1821341074
Name:PADILLA, MARYBELL (DPT)
Entity Type:Individual
Prefix:
First Name:MARYBELL
Middle Name:
Last Name:PADILLA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14291 SW 120TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7287
Mailing Address - Country:US
Mailing Address - Phone:305-385-0168
Mailing Address - Fax:305-385-0182
Practice Address - Street 1:8720 N KENDALL DR
Practice Address - Street 2:SUITE 206
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2299
Practice Address - Country:US
Practice Address - Phone:305-595-9425
Practice Address - Fax:305-595-8492
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-24
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27807225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007192000Medicaid