Provider Demographics
NPI:1770658650
Name:SURATOS, ADRIAN DIAZ (PT)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:DIAZ
Last Name:SURATOS
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 1:1901 N ANDREWS AVE
Mailing Address - Street 2:UNIT 100
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33311-3935
Mailing Address - Country:US
Mailing Address - Phone:954-682-4217
Mailing Address - Fax:
Practice Address - Street 1:1475 NW 14TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-1616
Practice Address - Country:US
Practice Address - Phone:305-547-4736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10734225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist