Provider Demographics
NPI:1972016657
Name:BUSUTIL VALDES, AMADOR (PTA)
Entity Type:Individual
Prefix:MR
First Name:AMADOR
Middle Name:
Last Name:BUSUTIL VALDES
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12888 SW 151ST LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6378
Mailing Address - Country:US
Mailing Address - Phone:786-442-8923
Mailing Address - Fax:
Practice Address - Street 1:7911 NW 72ND AVE STE 116A
Practice Address - Street 2:
Practice Address - City:MEDLEY
Practice Address - State:FL
Practice Address - Zip Code:33166-2222
Practice Address - Country:US
Practice Address - Phone:786-442-8923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-16
Last Update Date:2017-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA28128225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty