Provider Demographics
NPI:1255540803
Name:ANAYA, LUIS MANUEL (PT)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:MANUEL
Last Name:ANAYA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7177 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-1050
Mailing Address - Country:US
Mailing Address - Phone:954-432-6829
Mailing Address - Fax:954-432-0987
Practice Address - Street 1:7177 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313-1050
Practice Address - Country:US
Practice Address - Phone:954-432-6829
Practice Address - Fax:954-432-0987
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 7955225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7799ZMedicare PIN