Provider Demographics
NPI:1316549462
Name:MAZPULE, JESSICA RODRIGUEZ (PTA)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RODRIGUEZ
Last Name:MAZPULE
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 1:6100 SW 93RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1532
Mailing Address - Country:US
Mailing Address - Phone:786-543-7428
Mailing Address - Fax:
Practice Address - Street 1:7762 N KENDALL DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7523
Practice Address - Country:US
Practice Address - Phone:305-598-0229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA28032225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant