Individual
AILSA VIDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4262 SW 68TH CT, MIAMI, FL 33155-4749
(305) 546-5333
Mailing address
4312 SW 68TH CT, MIAMI, FL 33155-4750
(305) 546-5333
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA25059
LICENSE NUMBER
FL
Enumeration date
01/15/2015
Last updated
09/29/2023
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