Provider Demographics
NPI:1154750487
Name:AREVALO, ANIKA
Entity type:Individual
Prefix:
First Name:ANIKA
Middle Name:
Last Name:AREVALO
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 1:6900 SW 44TH ST
Mailing Address - Street 2:BLD G APT 103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-4788
Mailing Address - Country:US
Mailing Address - Phone:214-728-1854
Mailing Address - Fax:
Practice Address - Street 1:8950 SW 74TH CT
Practice Address - Street 2:SUITE 1206
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-3171
Practice Address - Country:US
Practice Address - Phone:786-623-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011297225100000X
FLPT30293225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist