Provider Demographics
NPI:1295913432
Name:LAW, DARRYL
Entity type:Individual
Prefix:
First Name:DARRYL
Middle Name:
Last Name:LAW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13455 SW 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2675
Mailing Address - Country:US
Mailing Address - Phone:866-907-4797
Mailing Address - Fax:866-908-4797
Practice Address - Street 1:13455 SW 22ND ST
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2675
Practice Address - Country:US
Practice Address - Phone:866-907-4797
Practice Address - Fax:866-908-4797
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20112225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist