Healthcare Provider Details

I. General information

NPI: 1285151498
Provider Name (Legal Business Name): RONALD MEZA DPT, PT, ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 TECHNOLOGICAL AVE
ORLANDO FL
32817-8353
US

IV. Provider business mailing address

11058 FAIRHAVEN WAY
ORLANDO FL
32825-7110
US

V. Phone/Fax

Practice location:
  • Phone: 407-681-2520
  • Fax:
Mailing address:
  • Phone: 201-870-7879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number4267
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number38355
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: