Provider Demographics
NPI:1699038992
Name:MOURINO, JUDITH (MECHANO THERAPIST)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:MOURINO
Suffix:
Gender:F
Credentials:MECHANO THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9369 FOUNTAINBLEAU BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-5686
Mailing Address - Country:US
Mailing Address - Phone:786-970-2542
Mailing Address - Fax:786-275-4132
Practice Address - Street 1:9369 FOUNTAINBLEU BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172
Practice Address - Country:US
Practice Address - Phone:786-970-2542
Practice Address - Fax:786-275-4132
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA65381172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist