Provider Demographics
NPI:1013457803
Name:HIDALGO, TAMARA (DPT)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:HIDALGO
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 1:3655 NW 107TH AVE
Mailing Address - Street 2:STE. 107
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-4327
Mailing Address - Country:US
Mailing Address - Phone:786-452-0774
Mailing Address - Fax:785-452-0764
Practice Address - Street 1:3655 NW 107TH AVE
Practice Address - Street 2:STE. 107
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-4327
Practice Address - Country:US
Practice Address - Phone:786-452-0774
Practice Address - Fax:785-452-0764
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT32095OtherPT LICENSE