| Liv Active Therapy Center | |
|
9495 Sw 72nd St # B120 Miami FL 33173-3253 | |
| (786) 332-2672 | |
| (786) 369-7054 |
| Full Name | Liv Active Therapy Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 9495 Sw 72nd St # B120, Miami, Florida |
| Authorized Official Name and Position | Gyasi Azpeitia (OWNER) |
| Authorized Official Contact | 7863322672 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Liv Active Therapy Center 10610 Sw 148th Avenue Dr Miami FL 33196-2453 Ph: (786) 346-6841 | Liv Active Therapy Center 9495 Sw 72nd St # B120 Miami FL 33173-3253 Ph: (786) 332-2672 |
| NPI Number | 1922556307 |
|---|---|
| Provider Enumeration Date | 09/14/2016 |
| Last Update Date | 05/01/2023 |
| Certification Date | 05/01/2023 |
| Medicare PECOS PAC ID | 8628351954 |
|---|---|
| Medicare Enrollment ID | O20170213001450 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922556307 | NPI | - | NPPES |
| 025097100 | Medicaid | FL | |
| 1144332420 | Other | FL | NPPES |
| Provider Name | Gyasi Azpeitia |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1144332420 PECOS PAC ID: 3173426426 Enrollment ID: I20170213001683 |
| Provider Name | Kevin Alexander Fernandez |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1750928867 PECOS PAC ID: 1557790425 Enrollment ID: I20200330001227 |
| Provider Name | Kevin Valledor |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1942194543 PECOS PAC ID: 5991292203 Enrollment ID: I20251013000013 |
| Provider Name | Jasmin Sanbartolome |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1346766334 PECOS PAC ID: 0840766226 Enrollment ID: I20260414004165 |
| Provider Name | Alberto Blanco |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1427876648 PECOS PAC ID: 8123594751 Enrollment ID: I20260420003389 |
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