Provider Demographics
NPI:1013403252
Name:PINEDA, JEANNETTE R
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:R
Last Name:PINEDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 SW 137TH AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-1435
Mailing Address - Country:US
Mailing Address - Phone:305-382-9991
Mailing Address - Fax:305-382-9550
Practice Address - Street 1:9000 SW 137TH AVE STE 116
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1435
Practice Address - Country:US
Practice Address - Phone:305-382-9991
Practice Address - Fax:305-382-9550
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA18939225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant