Provider Demographics
NPI:1083445043
Name:PETEROS, RAYNEL-JAN (DPT)
Entity type:Individual
Prefix:DR
First Name:RAYNEL-JAN
Middle Name:
Last Name:PETEROS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:RAYNEL-JAN
Other - Middle Name:
Other - Last Name:PETEROS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:11400 N KENDALL DR STE 206
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1029
Mailing Address - Country:US
Mailing Address - Phone:786-534-9846
Mailing Address - Fax:786-534-7246
Practice Address - Street 1:11400 N KENDALL DR STE 206
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1029
Practice Address - Country:US
Practice Address - Phone:786-534-9846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40143261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy