Provider Demographics
NPI:1336508738
Name:TREVISAN, DIOGO (PT)
Entity Type:Individual
Prefix:
First Name:DIOGO
Middle Name:
Last Name:TREVISAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 SUNSET DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3746
Mailing Address - Country:US
Mailing Address - Phone:305-274-3311
Mailing Address - Fax:305-274-1411
Practice Address - Street 1:8585 SUNSET DR
Practice Address - Street 2:SUITE 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-3746
Practice Address - Country:US
Practice Address - Phone:305-274-3311
Practice Address - Fax:305-274-1411
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT31195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist