Provider Demographics
NPI:1275915340
Name:SAGARDUY SUSTACHA, BEATRIZ (DPT)
Entity Type:Individual
Prefix:DR
First Name:BEATRIZ
Middle Name:
Last Name:SAGARDUY SUSTACHA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:BEATRIZ
Other - Middle Name:
Other - Last Name:SAGARDUY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:7180 E LAGO DR
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6512
Mailing Address - Country:US
Mailing Address - Phone:786-223-7410
Mailing Address - Fax:
Practice Address - Street 1:12651 S DIXIE HWY
Practice Address - Street 2:#205
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-5975
Practice Address - Country:US
Practice Address - Phone:305-232-9222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-24
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30453225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist