Provider Demographics
NPI:1821532821
Name:MACHADO, LIANET (PTA)
Entity Type:Individual
Prefix:
First Name:LIANET
Middle Name:
Last Name:MACHADO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14030 SW 39TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6423
Mailing Address - Country:US
Mailing Address - Phone:305-728-9168
Mailing Address - Fax:188-633-0531
Practice Address - Street 1:14030 SW 39TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6423
Practice Address - Country:US
Practice Address - Phone:305-728-9168
Practice Address - Fax:188-633-0531
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23231225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant