Provider Demographics
NPI:1336377266
Name:CAMACHO, MARIA PAULA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:PAULA
Last Name:CAMACHO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:MARIA
Other - Middle Name:PAULA
Other - Last Name:MARQUES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:4988 N UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5748
Mailing Address - Country:US
Mailing Address - Phone:954-746-7230
Mailing Address - Fax:
Practice Address - Street 1:4988 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33351-5748
Practice Address - Country:US
Practice Address - Phone:954-746-7230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21675225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant