Provider Demographics
NPI:1124575758
Name:MOSQUEIRA, RAUL M SR (MA 77299, PTA 30010)
Entity Type:Individual
Prefix:MR
First Name:RAUL
Middle Name:M
Last Name:MOSQUEIRA
Suffix:SR
Gender:M
Credentials:MA 77299, PTA 30010
Other - Prefix:MR
Other - First Name:RAUL
Other - Middle Name:
Other - Last Name:MOSQUEIRA
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:NEUROMUSCULAR CERTIF
Mailing Address - Street 1:2575 SW 27TH AVE
Mailing Address - Street 2:108
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2160
Mailing Address - Country:US
Mailing Address - Phone:786-587-4481
Mailing Address - Fax:
Practice Address - Street 1:2911 BRIDGEPORT AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-3607
Practice Address - Country:US
Practice Address - Phone:786-587-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA7299225700000X, 225700000X
FLPTA30010225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant