Provider Demographics
NPI:1952697393
Name:PRADO, MELINDA TUBERA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:TUBERA
Last Name:PRADO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:720 WINSLOW STREET
Mailing Address - Street 2:
Mailing Address - City:HERTFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27944
Mailing Address - Country:US
Mailing Address - Phone:954-999-3728
Mailing Address - Fax:954-942-1130
Practice Address - Street 1:925 S SEMORAN BLVD
Practice Address - Street 2:108
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-5313
Practice Address - Country:US
Practice Address - Phone:877-430-2772
Practice Address - Fax:800-521-9608
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist