Provider Demographics
NPI:1558791533
Name:MORENO, ANNETTE ELGARRESTA (DPT)
Entity Type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:ELGARRESTA
Last Name:MORENO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7762 N KENDALL DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7523
Mailing Address - Country:US
Mailing Address - Phone:305-598-0229
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?:No
Enumeration Date:2013-11-12
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT28761225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist