Provider Demographics
NPI:1912076498
Name:DENIS, NIDIA S (PTA)
Entity Type:Individual
Prefix:MRS
First Name:NIDIA
Middle Name:S
Last Name:DENIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1280 SW 1ST ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-2450
Mailing Address - Country:US
Mailing Address - Phone:305-649-5649
Mailing Address - Fax:305-649-5650
Practice Address - Street 1:1280 SW 1ST ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2450
Practice Address - Country:US
Practice Address - Phone:305-649-5649
Practice Address - Fax:305-649-5650
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA1742225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA1742OtherMQA