Provider Demographics
NPI:1851875355
Name:MASEDA, PEDRO ENRIQUE (DPT)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:ENRIQUE
Last Name:MASEDA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9092 SEAFAIR LN
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-8187
Mailing Address - Country:US
Mailing Address - Phone:305-720-6056
Mailing Address - Fax:
Practice Address - Street 1:BRYNWOOD HEALTH REHAB
Practice Address - Street 2:1656 JEFFERSON STREET
Practice Address - City:MONTICELLO
Practice Address - State:FL
Practice Address - Zip Code:32344
Practice Address - Country:US
Practice Address - Phone:850-997-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23725208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation