Individual provider · NPI-1

Johnny Bustamante

Physical Therapy Assistant · Doral, FL

NPI number1891114880
StatusActive
Last updated in NPPESApr 7, 2014

Details

NPI
1891114880
Entity type
Individual (NPI-1)
Name
Johnny Bustamante
Sex
Male
Sole proprietor
Yes
Enumeration date
Apr 7, 2014
Last updated
Apr 7, 2014

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
225200000X Physical Therapy AssistantPTA23842FLYes

Practice location

3900 Nw 79th Ave Ste 500
Doral, FL 33166-6549

Phone 305-591-4181

Mailing address

13700 Sw 149th Circle Ln Apt 1
Miami, FL 33186-8257

Phone 786-487-5969

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