Individual
MIBSAM LISSETTE HERRERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1811 NE 146TH ST, NORTH MIAMI, FL 33181-1423
(305) 949-4191
(305) 949-4833
Mailing address
1811 NE 146TH ST, NORTH MIAMI, FL 33181-1423
(305) 949-4191
(305) 949-4833
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA1491
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
Y902J
BLUE CROSS BLUE SHIELD
FL
Enumeration date
09/25/2007
Last updated
07/23/2008
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