1740231075 NPI number — PATRICIA FREIRE PT

Table of content: PATRICIA FREIRE PT (NPI 1740231075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740231075 NPI number — PATRICIA FREIRE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREIRE
Provider First Name:
PATRICIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740231075
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14400 STIRLING RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SW RANCHES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33330-2908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-357-1535
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11400 STIRLING ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SW RANCHES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-357-1535
Provider Business Practice Location Address Fax Number:
305-262-4004
Provider Enumeration Date:
05/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT13065 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PT13065 . This is a "LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 114294500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".