Provider Demographics
NPI:1285753988
Name:NIEVES, JAZMIN E (PT)
Entity type:Individual
Prefix:
First Name:JAZMIN
Middle Name:E
Last Name:NIEVES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 SW 8TH ST
Mailing Address - Street 2:111-113
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2300
Mailing Address - Country:US
Mailing Address - Phone:305-333-7936
Mailing Address - Fax:
Practice Address - Street 1:5200 SW 8TH ST
Practice Address - Street 2:111-113
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-2300
Practice Address - Country:US
Practice Address - Phone:305-333-7936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19110225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT19110OtherPHYSICAL THERAPIST