Provider Demographics
NPI:1922185784
Name:GERENA, CANDIDO JR (PTA)
Entity Type:Individual
Prefix:MR
First Name:CANDIDO
Middle Name:
Last Name:GERENA
Suffix:JR
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9596 SW 5TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2120
Mailing Address - Country:US
Mailing Address - Phone:305-227-5685
Mailing Address - Fax:
Practice Address - Street 1:1893 NE MIAMI GARDENS DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-5035
Practice Address - Country:US
Practice Address - Phone:305-682-0080
Practice Address - Fax:305-682-0775
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1414225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant