Provider Demographics
NPI:1841570389
Name:JEAN-LOUIS, JIRDELLE (PTA)
Entity Type:Individual
Prefix:
First Name:JIRDELLE
Middle Name:
Last Name:JEAN-LOUIS
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 1:745 NW 134TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-2824
Mailing Address - Country:US
Mailing Address - Phone:786-553-7750
Mailing Address - Fax:
Practice Address - Street 1:745 NW 134TH ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-2824
Practice Address - Country:US
Practice Address - Phone:786-553-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 22397225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant