Healthcare Provider Details

I. General information

NPI: 1194741140
Provider Name (Legal Business Name): LUIS C MEJIA P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 05/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3729 FALCON RIDGE CIR
WESTON FL
33331-5021
US

IV. Provider business mailing address

3729 FALCON RIDGE CIR
WESTON FL
33331-5021
US

V. Phone/Fax

Practice location:
  • Phone: 954-632-8535
  • Fax: 954-659-0584
Mailing address:
  • Phone: 954-632-8535
  • Fax: 954-659-0584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT20330
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: