Provider Demographics
NPI:1437509809
Name:BARROSO, ODALYS
Entity type:Individual
Prefix:
First Name:ODALYS
Middle Name:
Last Name:BARROSO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 NW 6TH LN APT 209
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3852
Mailing Address - Country:US
Mailing Address - Phone:786-252-2211
Mailing Address - Fax:
Practice Address - Street 1:8585 NW 6TH LN APT 209
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-3852
Practice Address - Country:US
Practice Address - Phone:786-252-2211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 25897225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant