Provider Demographics
NPI:1194149740
Name:MIGUEL, RENATO LASAM JR (PT)
Entity type:Individual
Prefix:MR
First Name:RENATO
Middle Name:LASAM
Last Name:MIGUEL
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16089 POPPYSEED CIRCLE, SUITE 2008
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484
Mailing Address - Country:US
Mailing Address - Phone:561-699-3714
Mailing Address - Fax:
Practice Address - Street 1:16089 POPPYSEED CIR UNIT 2008
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6314
Practice Address - Country:US
Practice Address - Phone:561-699-3714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist