Provider Demographics
NPI:1649326794
Name:PRO, JAVIER MARTIN (PT)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:MARTIN
Last Name:PRO
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 1:17003 S.W. 79 PLACE
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157
Mailing Address - Country:US
Mailing Address - Phone:305-968-1849
Mailing Address - Fax:786-242-8269
Practice Address - Street 1:300 SEVILLA AVE
Practice Address - Street 2:304
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6636
Practice Address - Country:US
Practice Address - Phone:305-445-4224
Practice Address - Fax:305-445-4224
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT6756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist