Provider Demographics
NPI:1093912263
Name:PEDRAZA, JUNTREE (PTA)
Entity Type:Individual
Prefix:
First Name:JUNTREE
Middle Name:
Last Name:PEDRAZA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1640 NW 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-2950
Mailing Address - Country:US
Mailing Address - Phone:305-216-8890
Mailing Address - Fax:
Practice Address - Street 1:18001 OLD CUTLER RD
Practice Address - Street 2:SUITE 354
Practice Address - City:VILLAGE OF PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6422
Practice Address - Country:US
Practice Address - Phone:305-251-7477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 20824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist