Provider Demographics
NPI:1376575084
Name:VIDAL, FLOR MARIA (MPT)
Entity type:Individual
Prefix:MS
First Name:FLOR MARIA
Middle Name:
Last Name:VIDAL
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 80TH ST APT A
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-1502
Mailing Address - Country:US
Mailing Address - Phone:786-587-9351
Mailing Address - Fax:
Practice Address - Street 1:1140 W 50TH ST STE 208
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3438
Practice Address - Country:US
Practice Address - Phone:305-698-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1176CMedicare ID - Type Unspecified