Active NPI
Lara Elaine Roa Pabalan, PT
- Physical Therapist
- Sunrise, FL
National Provider Identifier
1568925261
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT5248
- Practice address
- 1580 Sawgrass Corporate Pkwy Ste 200
Sunrise, FL 33323-2869 - Phone
- (954) 332-4474
- NPI assigned
- Apr 9, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT5248 | NM | Primary |
Addresses
Primary practice location
1580 Sawgrass Corporate Pkwy Ste 200
Sunrise, FL 33323-2869
Mailing address
1580 Sawgrass Corporate Pkwy Ste 200
Sunrise, FL 33323-2869
Phone (954) 332-4474
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SSN | Medicaid | FL |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT5248 | NM | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554768000000",
"number": "1568925261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1580 SAWGRASS CORPORATE PKWY STE 200",
"city": "SUNRISE",
"state": "FL",
"postal_code": "333232869",
"telephone_number": "954-332-4474"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1580 SAWGRASS CORPORATE PKWY STE 200",
"city": "SUNRISE",
"state": "FL",
"postal_code": "333232869",
"telephone_number": "954-332-4474"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PABALAN",
"first_name": "LARA ELAINE",
"middle_name": "ROA",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-04-09",
"last_updated": "2019-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NM",
"license": "PT5248",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SSN",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sunrise, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.