Provider Demographics
NPI:1659495208
Name:FRAGA, ANA MARIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANA
Middle Name:MARIA
Last Name:FRAGA
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 1:11343 SW 69TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1905
Mailing Address - Country:US
Mailing Address - Phone:305-270-1456
Mailing Address - Fax:
Practice Address - Street 1:3117 SW 13TH CT
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-2714
Practice Address - Country:US
Practice Address - Phone:954-584-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0001974225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist