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General NPI Number Information
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NPI Number | 1124575758
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Entity Type | Individual
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Provider Name | RAUL M MOSQUEIRA SR. MA 77299, PTA 30010
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Gender | Male
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 03/05/2020
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Provider Practice Location Address
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Address Line | 2911 BRIDGEPORT AVE
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City | MIAMI
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State | FL
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Zip | 33133-3607
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Country | US
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Telephone | 786-587-4481
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Fax |
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Provider Business Mailing Address
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Address Line | 2575 SW 27TH AVE 108
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City | MIAMI
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State | FL
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Zip | 33133-2160
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Country | US
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Telephone | 786-587-4481
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA7299
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA30010
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License Number State | FL
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