Provider Demographics
NPI:1972760346
Name:RAFAEL, CARMINA LAGAREJOS (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CARMINA
Middle Name:LAGAREJOS
Last Name:RAFAEL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MINNIE
Other - Middle Name:L
Other - Last Name:RAFAEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT, GCS, CEEAA
Mailing Address - Street 1:125 NE 121ST TER
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5342
Mailing Address - Country:US
Mailing Address - Phone:904-434-9445
Mailing Address - Fax:
Practice Address - Street 1:21251 E DIXIE HWY
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1218
Practice Address - Country:US
Practice Address - Phone:305-935-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist