Organization
MYOACTIVE REHABILITATION, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAVIER BUSUTIL PT, DPT (OWNER)
(305) 281-5124
Entity
Organization
Contact information
Practice address
2786 NW 79TH AVE, DORAL, FL 33122-1067
(305) 281-5124
(305) 960-7629
Mailing address
2825 SW 145TH AVE, MIAMI, FL 33175-7442
(305) 281-5124
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
—
—
2251P0200X
Pediatric Physical Therapist
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Enumeration date
04/22/2020
Last updated
05/20/2021
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