# THIAGO QUEIROZ DO PA, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386364495
- **Authorized official:** THIAGO QUEIROZ DO (PRESIDENT)
- **Authorized official phone:** (205) 835-4655

## Contact information

- **Practice address:** 3487 NW 30TH ST, LAUDERDALE LAKES, FL 33311-1103
- **Practice address phone:** (205) 835-4655
- **Mailing address:** 10741 SW 53RD ST, COOPER CITY, FL 33328-5639
- **Mailing address phone:** (205) 835-4655

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/30/2022
- **Last updated:** 08/30/2022