Provider Demographics
NPI:1609965227
Name:PRADEL, JEAN PASCAL (RPT)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:PASCAL
Last Name:PRADEL
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18600 NW 87TH AVE UNIT 126
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3536
Mailing Address - Country:US
Mailing Address - Phone:954-869-4310
Mailing Address - Fax:305-869-4313
Practice Address - Street 1:18600 NW 87TH AVE UNIT 126
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3536
Practice Address - Country:US
Practice Address - Phone:954-869-4310
Practice Address - Fax:305-869-4313
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20304225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY101EOtherBLUE CROSS BLUE SHIELD
FL023894300Medicaid