Provider Demographics
NPI:1336573039
Name:MIRTA BATISTA TATUM INC
Entity Type:Organization
Organization Name:MIRTA BATISTA TATUM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRTA
Authorized Official - Middle Name:BATISTA
Authorized Official - Last Name:TATUM
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:754-246-0625
Mailing Address - Street 1:4767 SW 195TH TER
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-6209
Mailing Address - Country:US
Mailing Address - Phone:754-246-0625
Mailing Address - Fax:
Practice Address - Street 1:4767 SW 195TH TER
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-6209
Practice Address - Country:US
Practice Address - Phone:754-246-0625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0004025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty