Basic Information
| Provider Information | |||||||||
| NPI: | 1396043253 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COLLAZO | ||||||||
| FirstName: | ARIADNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 BAYVIEW DR APT 1610 | ||||||||
| Address2: | |||||||||
| City: | SUNNY ISLES BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331604759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544378099 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 15346 NW 79TH CT | ||||||||
| Address2: | |||||||||
| City: | MIAMI LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330165850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3058210502 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/02/2011 | ||||||||
| LastUpdateDate: | 09/05/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | AL1212 | FL | N | Other Service Providers | Specialist | 225100000X | PT27007 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.