Provider Demographics
NPI:1417596818
Name:MIA THERAPY PRO INC
Entity type:Organization
Organization Name:MIA THERAPY PRO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAURICIO OSCAR
Authorized Official - Middle Name:GONZALEZ
Authorized Official - Last Name:REYNALDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-370-8729
Mailing Address - Street 1:6165 SW 130TH AVE APT 1310
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5234
Mailing Address - Country:US
Mailing Address - Phone:786-370-8729
Mailing Address - Fax:305-830-9043
Practice Address - Street 1:6165 SW 130TH AVE APT 1310
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-5234
Practice Address - Country:US
Practice Address - Phone:786-370-8729
Practice Address - Fax:305-830-9043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center