Provider Demographics
NPI:1528335064
Name:FUENTES, TATIANA MARIE (DPT)
Entity type:Individual
Prefix:MS
First Name:TATIANA
Middle Name:MARIE
Last Name:FUENTES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12060 SW 129TH CT
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4581
Mailing Address - Country:US
Mailing Address - Phone:305-378-5247
Mailing Address - Fax:
Practice Address - Street 1:12060 SW 129TH CT
Practice Address - Street 2:SUITE 107
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4581
Practice Address - Country:US
Practice Address - Phone:305-378-5247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27034225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist