Healthcare Provider Details

I. General information

NPI: 1477868131
Provider Name (Legal Business Name): NINA CHRISTONI CARREON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2010
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1736 S CONGRESS AVE
PALM SPRINGS FL
33461-2140
US

IV. Provider business mailing address

6950 NW 12TH ST
MARGATE FL
33063-2449
US

V. Phone/Fax

Practice location:
  • Phone: 561-649-0321
  • Fax:
Mailing address:
  • Phone: 954-871-1391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA22257
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: