Provider Demographics
NPI:1013247170
Name:BRAVO, MARIA A (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:A
Last Name:BRAVO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:A
Other - Last Name:BRAVO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:897 N HOMESTEAD BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-5024
Mailing Address - Country:US
Mailing Address - Phone:786-217-0014
Mailing Address - Fax:786-217-0020
Practice Address - Street 1:897 N HOMESTEAD BLVD STE 101
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-5024
Practice Address - Country:US
Practice Address - Phone:786-217-0014
Practice Address - Fax:786-217-0020
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24858225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist