Provider Demographics
NPI:1811232549
Name:MCBRIDE-RAMOS, LENA (PTA)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:MCBRIDE-RAMOS
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 1:2124 MALLARD CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34743-3522
Mailing Address - Country:US
Mailing Address - Phone:407-791-2170
Mailing Address - Fax:
Practice Address - Street 1:2124 MALLARD CREEK CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-3522
Practice Address - Country:US
Practice Address - Phone:407-791-2170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23637225200000X
FL31804225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist