Individual
RIVAZZELLY BASTARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
900 W 49TH ST STE 332, HIALEAH, FL 33012-3489
(786) 879-5303
Mailing address
18965 NW 62ND AVE APT 212, HIALEAH, FL 33015-5057
(786) 901-0053
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA30057
FL
Other
Enumeration date
02/24/2020
Last updated
02/24/2020
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