Provider Demographics
NPI:1942762703
Name:WRATHELL, DINA (PT)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:WRATHELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16249 BISCAYNE BLVD
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4300
Mailing Address - Country:US
Mailing Address - Phone:305-405-0400
Mailing Address - Fax:305-405-0400
Practice Address - Street 1:8430 BLUE MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33473-5080
Practice Address - Country:US
Practice Address - Phone:954-474-3611
Practice Address - Fax:954-474-3613
Is Sole Proprietor?:No
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT16477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist