Basic Information
Provider Information
NPI: 1679915938
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MOISES
FirstName: OSCAR
MiddleName: ROBILLOS
NamePrefix: MR.
NameSuffix: II
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1580 SAWGRASS CORPORATE PKWY
Address2: SUITE 100
City: SUNRISE
State: FL
PostalCode: 333232859
CountryCode: US
TelephoneNumber: 9543324445
FaxNumber: 8664226431
Practice Location
Address1: 1580 SAWGRASS CORPORATE PKWY
Address2: SUITE 100
City: SUNRISE
State: FL
PostalCode: 333232859
CountryCode: US
TelephoneNumber: 9543324445
FaxNumber: 8664226431
Other Information
ProviderEnumerationDate: 07/26/2013
LastUpdateDate: 07/26/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X1224911TXY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


Home