Individual
JOHNNY BUSTAMANTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3900 NW 79TH AVE STE 500, DORAL, FL 33166-6549
(305) 591-4181
Mailing address
13700 SW 149TH CIRCLE LN APT 1, MIAMI, FL 33186-8257
(786) 487-5969
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA23842
FL
Other
Enumeration date
04/07/2014
Last updated
04/07/2014
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