Provider Demographics
NPI:1265599062
Name:MENDOZA, CARLA LORENA (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:LORENA
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 SW 153RD CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4709
Mailing Address - Country:US
Mailing Address - Phone:305-244-4531
Mailing Address - Fax:
Practice Address - Street 1:7425 SW 42ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-4402
Practice Address - Country:US
Practice Address - Phone:305-262-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist