Healthcare Provider Details

I. General information

NPI: 1376707844
Provider Name (Legal Business Name): MEJIA PHYSICAL THERAPY AND WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2008
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: MR. LUIS C MEJIA
Title or Position: DIRECTOR
Credential: M.A., P.T.
Phone: 954-632-8535