Provider Demographics
NPI:1790160430
Name:PENA, ZAIRIS (PTA)
Entity Type:Individual
Prefix:
First Name:ZAIRIS
Middle Name:
Last Name:PENA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 CALABRIA AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3027
Mailing Address - Country:US
Mailing Address - Phone:305-896-6265
Mailing Address - Fax:
Practice Address - Street 1:126 CALABRIA AVE
Practice Address - Street 2:APT 1
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3027
Practice Address - Country:US
Practice Address - Phone:305-896-6265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24779225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant