Provider Demographics
NPI:1184096232
Name:ALCANTARA, FREIRE (DPT, CSCS, ATC)
Entity type:Individual
Prefix:DR
First Name:FREIRE
Middle Name:
Last Name:ALCANTARA
Suffix:
Gender:M
Credentials:DPT, CSCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8262 GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3715
Mailing Address - Country:US
Mailing Address - Phone:954-368-4598
Mailing Address - Fax:954-530-2369
Practice Address - Street 1:8262 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3715
Practice Address - Country:US
Practice Address - Phone:954-368-4598
Practice Address - Fax:954-530-2369
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-28
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist