Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA18939 | FL |
NPI | 1013403252 |
---|---|
Provider Name | Jeannette R Pineda |
First Address | Miami, FL 33186-1435 |
Second Address | Miami, FL 33186-1435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2018 |
Last Update Date | 10/07/2018 |