Provider Demographics
NPI:1356043376
Name:PETROLATI, BENJAMIN (PT)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:PETROLATI
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 1:4700 SW 67TH AVE APT P8
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5883
Mailing Address - Country:US
Mailing Address - Phone:786-622-8069
Mailing Address - Fax:
Practice Address - Street 1:80 SW 8TH ST STE 2000
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-3038
Practice Address - Country:US
Practice Address - Phone:786-622-8069
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA92229225700000X
FLPT37178225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist