Individual provider Active NPI

Mariana Talarico de Nolasco, PT

  • Physical Therapist
  • Hollywood, FL
National Provider Identifier
1548314578
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT 21718 Issued in FL
Practice address
3670 N 54TH Ave
Hollywood, FL 33021-2340
Phone
(305) 651-9311
Fax
(754) 201-1390
NPI assigned
Jan 23, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT 21718 FL Primary
Developmental Therapist 222Q00000X NU

Addresses

Primary practice location

3670 N 54TH Ave
Hollywood, FL 33021-2340

Mailing address

3670 N 54TH Ave
Hollywood, FL 33021-2340
Phone (305) 651-9311

Other practice location 1

4620 Fillmore St
Hollywood, FL 33021-5814
Phone (305) 651-9311

Other identifiers 1

IdentifierTypeStateIssuer
891721300MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PT 21718FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
123 Therapy Inc. Current Accepting new patients
123 Therapy Inc. Physical Therapist Current Accepting new patients
123 Special Care Kids Ppec LLC Physical Therapist Current Accepting new patients

Locations

14040 NW 7th Ave
Miami, FL 33168
Phone (305) 651-9311

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1548314578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3670 N 54TH AVE",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330212340",
            "telephone_number": "305-651-9311",
            "fax_number": "754-201-1390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3670 N 54TH AVE",
            "city": "HOLLYWOOD",
            "state": "FL",
            "postal_code": "330212340",
            "telephone_number": "305-651-9311",
            "fax_number": "754-201-1390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4620 Fillmore St",
            "address_purpose": "LOCATION",
            "city": "Hollywood",
            "state": "FL",
            "postal_code": "330215814",
            "country_code": "US",
            "telephone_number": "305-651-9311",
            "fax_number": "754-201-1390",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TALARICO DE NOLASCO",
        "first_name": "MARIANA",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-23",
        "last_updated": "2022-07-21",
        "certification_date": "2020-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT 21718",
            "primary": true
        },
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891721300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hollywood, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.