Individual
MISS LISSA MARIA CARABALLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7800 S RED RD STE 205, SOUTH MIAMI, FL 33143-5542
(305) 854-2471
Mailing address
6933 SW 166TH CT, MIAMI, FL 33193-5558
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA30473
FL
Other
Enumeration date
04/18/2022
Last updated
04/18/2022
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