Provider Demographics
NPI:1891093373
Name:ENAJE, BRYANT AVILES (RPT)
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:AVILES
Last Name:ENAJE
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 W COMMERCIAL BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3444
Mailing Address - Country:US
Mailing Address - Phone:954-332-4445
Mailing Address - Fax:866-422-6431
Practice Address - Street 1:3201 W COMMERCIAL BLVD STE 116
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-3444
Practice Address - Country:US
Practice Address - Phone:954-332-4445
Practice Address - Fax:866-422-6431
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist