Provider Demographics
NPI:1578760765
Name:MONTERO, ANNABELLE JORGE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:ANNABELLE
Middle Name:JORGE
Last Name:MONTERO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14435 SW 96TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7814
Mailing Address - Country:US
Mailing Address - Phone:305-807-7566
Mailing Address - Fax:305-253-7469
Practice Address - Street 1:14435 SW 96TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7814
Practice Address - Country:US
Practice Address - Phone:305-807-7566
Practice Address - Fax:305-253-7469
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 22127225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891179700Medicaid