Provider Demographics
NPI:1740017300
Name:MICALI, LAURA JEANNE (MSPT)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:JEANNE
Last Name:MICALI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7783 SW 192ND ST
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8050
Mailing Address - Country:US
Mailing Address - Phone:786-368-7771
Mailing Address - Fax:
Practice Address - Street 1:7232 SW 39TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6624
Practice Address - Country:US
Practice Address - Phone:786-409-3254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT-0010269225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist