Provider Demographics
NPI:1649395955
Name:MENDONCA, ADRIANA M (PT)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:M
Last Name:MENDONCA
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 1:19242 SW 65TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33332-3361
Mailing Address - Country:US
Mailing Address - Phone:954-680-3712
Mailing Address - Fax:
Practice Address - Street 1:19242 SW 65TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33332-3361
Practice Address - Country:US
Practice Address - Phone:954-680-3712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU0090Medicare ID - Type UnspecifiedFL MEDICARE