Provider Demographics
NPI:1912035569
Name:OTERO, FELIPE (MSPT)
Entity Type:Individual
Prefix:MR
First Name:FELIPE
Middle Name:
Last Name:OTERO
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11028 SW 132ND PL
Mailing Address - Street 2:UNIT #4
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7954
Mailing Address - Country:US
Mailing Address - Phone:786-355-2187
Mailing Address - Fax:305-382-4723
Practice Address - Street 1:11028 SW 132ND PL
Practice Address - Street 2:UNIT #4
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7954
Practice Address - Country:US
Practice Address - Phone:786-355-2187
Practice Address - Fax:305-382-4723
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22715225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY105ZOtherNON-PAR PROVIDER