Provider Demographics
NPI:1952806341
Name:SUAREZ, DIANA (PT)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12460 SW 184TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-3156
Mailing Address - Country:US
Mailing Address - Phone:786-780-7509
Mailing Address - Fax:
Practice Address - Street 1:13055 SW 42ND ST STE 104
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3470
Practice Address - Country:US
Practice Address - Phone:786-360-6125
Practice Address - Fax:786-431-5231
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225200000X
FLPTA261Q00000X
FLRBT-1864647106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center