Individual
NICOLE VIDAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14900 NW 79TH CT STE 101, MIAMI LAKES, FL 33016-5869
(305) 821-0502
(305) 362-5209
Mailing address
14900 NW 79TH CT STE 101, MIAMI LAKES, FL 33016-5869
(305) 821-0502
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
30831
FL
Other
Enumeration date
02/05/2021
Last updated
02/05/2021
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