# MYOACTIVE REHABILITATION, LLC

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

## Provider details

- **NPI number:** 1659991339
- **Authorized official:** DR. JAVIER BUSUTIL PT, DPT (OWNER)
- **Authorized official phone:** (305) 281-5124

## Contact information

- **Practice address:** 2786 NW 79TH AVE, DORAL, FL 33122-1067
- **Practice address phone:** (305) 281-5124
- **Practice address fax:** (305) 960-7629
- **Mailing address:** 2825 SW 145TH AVE, MIAMI, FL 33175-7442
- **Mailing address phone:** (305) 281-5124

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 2251P0200X | Pediatric Physical Therapist | — | NULL | — |
| 2251P0200X | Pediatric Physical Therapist | — | — | — |
| 225400000X | Rehabilitation Practitioner | — | NULL | Yes |
| 225400000X | Rehabilitation Practitioner | — | — | Yes |
| 225XP0200X | Pediatric Occupational Therapist | — | NULL | — |
| 225XP0200X | Pediatric Occupational Therapist | — | — | — |
| 235Z00000X | Speech-Language Pathologist | — | NULL | — |
| 235Z00000X | Speech-Language Pathologist | — | — | — |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 04/22/2020
- **Last updated:** 05/20/2021