Healthcare Provider Details

I. General information

NPI: 1922455252
Provider Name (Legal Business Name): ANNA MARIE ELIZABETH LUMBER CABRERA PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 05/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1359 E SAMPLE RD
POMPANO BEACH FL
33064-6278
US

IV. Provider business mailing address

5800 W SAMPLE RD APT 206
CORAL SPRINGS FL
33067-3234
US

V. Phone/Fax

Practice location:
  • Phone: 954-785-8252
  • Fax:
Mailing address:
  • Phone: 954-344-4145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2119536
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: