Organization
BLUELAKEPHYSICIAN GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TREVINE ROSHAN ALBERT I OS14935 (MEDICAL DIRECTOR)
(916) 225-6888
Entity
Organization
Contact information
Practice address
4800 W FLAGLER ST STE 212, CORAL GABLES, FL 33134-1401
(786) 703-3195
(786) 703-3195
Mailing address
4800 W FLAGLER ST STE 212, CORAL GABLES, FL 33134-1401
(786) 703-3195
(786) 703-3195
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
10/18/2021
Last updated
10/18/2021
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