Provider Demographics
NPI:1407907132
Name:VECINA, MONINA R (PT)
Entity Type:Individual
Prefix:MS
First Name:MONINA
Middle Name:R
Last Name:VECINA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 S ALEXANDER ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33563
Mailing Address - Country:US
Mailing Address - Phone:813-759-0106
Mailing Address - Fax:813-759-0161
Practice Address - Street 1:1507 S ALEXANDER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563
Practice Address - Country:US
Practice Address - Phone:813-759-0106
Practice Address - Fax:813-759-0161
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT9537225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist