Provider Demographics
NPI:1437304359
Name:PRADA, MARIA DE JESUS
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DE JESUS
Last Name:PRADA
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 1:16384 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1068
Mailing Address - Country:US
Mailing Address - Phone:786-251-2925
Mailing Address - Fax:
Practice Address - Street 1:2641 N FLAMINGO RD APT N-2108
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33323-1735
Practice Address - Country:US
Practice Address - Phone:786-251-2925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-19
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist