Provider Demographics
NPI:1760935050
Name:MESA, CRISTINA (ATC, LAT)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:
Last Name:MESA
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3313 W HILLSBORO BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-9423
Mailing Address - Country:US
Mailing Address - Phone:954-571-9500
Mailing Address - Fax:954-571-9560
Practice Address - Street 1:3313 W HILLSBORO BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9423
Practice Address - Country:US
Practice Address - Phone:954-571-9500
Practice Address - Fax:954-571-9560
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL39812255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer