Provider Demographics
NPI:1366911570
Name:FELIPE, JUSTIN (PTA)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:FELIPE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 SW 147TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5622
Mailing Address - Country:US
Mailing Address - Phone:305-207-0602
Mailing Address - Fax:305-207-0248
Practice Address - Street 1:2619 SW 147TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5622
Practice Address - Country:US
Practice Address - Phone:305-207-0602
Practice Address - Fax:305-207-0248
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA29056225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant