Provider Demographics
NPI:1972831105
Name:LARA, JOCELYN (DPT)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:LARA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8740 N KENDALL DR STE 115
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2209
Mailing Address - Country:US
Mailing Address - Phone:305-598-0229
Mailing Address - Fax:
Practice Address - Street 1:8740 N KENDALL DR STE 115
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2209
Practice Address - Country:US
Practice Address - Phone:305-598-0229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist