Provider Demographics
NPI:1831227388
Name:VILCHEZ, SORAYA (PTA)
Entity type:Individual
Prefix:MRS
First Name:SORAYA
Middle Name:
Last Name:VILCHEZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1482 NW 158TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2430
Mailing Address - Country:US
Mailing Address - Phone:954-432-0582
Mailing Address - Fax:305-592-6067
Practice Address - Street 1:8180 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6645
Practice Address - Country:US
Practice Address - Phone:305-592-5555
Practice Address - Fax:305-592-6067
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL18448225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant