Provider Demographics
NPI:1891893756
Name:DIAZ, RAUL H (PT)
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:H
Last Name:DIAZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15180 NW 6TH CT
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1830
Mailing Address - Country:US
Mailing Address - Phone:954-430-6030
Mailing Address - Fax:305-817-0926
Practice Address - Street 1:14004 NW 82ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1547
Practice Address - Country:US
Practice Address - Phone:305-817-0909
Practice Address - Fax:305-817-0926
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE8804AMedicare ID - Type Unspecified