Provider Demographics
NPI:1932681426
Name:MEJIA, CLARISSA L (PT)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:L
Last Name:MEJIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 SW 17TH ST # 209-229
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1271
Mailing Address - Country:US
Mailing Address - Phone:352-693-3378
Mailing Address - Fax:888-758-9645
Practice Address - Street 1:1050 OLD CAMP RD
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-1762
Practice Address - Country:US
Practice Address - Phone:352-693-3788
Practice Address - Fax:888-758-9645
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT32408225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT32408OtherSTATE OF FLORIDA