Healthcare Provider Details

I. General information

NPI: 1932681426
Provider Name (Legal Business Name): CLARISSA L MEJIA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2018
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 OLD CAMP RD
THE VILLAGES FL
32162-1762
US

IV. Provider business mailing address

1202 SW 17TH ST # 209-229
OCALA FL
34471-1271
US

V. Phone/Fax

Practice location:
  • Phone: 352-693-3788
  • Fax: 888-758-9645
Mailing address:
  • Phone: 352-693-3378
  • Fax: 888-758-9645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT32408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: