Provider Demographics
NPI:1942500129
Name:SELECTA PHYSICAL THERAPY, CORP.
Entity Type:Organization
Organization Name:SELECTA PHYSICAL THERAPY, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OSVALDO
Authorized Official - Middle Name:P
Authorized Official - Last Name:ANDRADE
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:786-953-6735
Mailing Address - Street 1:1393 SW 1ST ST
Mailing Address - Street 2:415
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135
Mailing Address - Country:US
Mailing Address - Phone:786-953-6735
Mailing Address - Fax:786-953-6943
Practice Address - Street 1:1393 SW 1ST ST
Practice Address - Street 2:415
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135
Practice Address - Country:US
Practice Address - Phone:786-953-6735
Practice Address - Fax:786-953-6943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty