Provider Demographics
NPI:1871045286
Name:DIAZ, JOSE DAUSEL SR (PTA)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:DAUSEL
Last Name:DIAZ
Suffix:SR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9800 BAHAMA DR
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-1557
Mailing Address - Country:US
Mailing Address - Phone:305-283-1529
Mailing Address - Fax:786-227-6211
Practice Address - Street 1:9800 BAHAMA DR
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33189-1557
Practice Address - Country:US
Practice Address - Phone:305-283-1529
Practice Address - Fax:786-227-6211
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA27160225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant