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General NPI Number Information
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NPI Number | 1679667869
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Entity Type | Individual
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Provider Name | JEANETTE MASEDA-LOPEZ PHYSICAL THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 2500 E HALLANDALE BEACH BLVD STE 611
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City | HALLANDALE BEACH
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State | FL
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Zip | 33009-4853
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Country | US
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Telephone | 954-454-2345
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Fax | 954-457-8242
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Provider Business Mailing Address
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Address Line | 9231 SW 66TH ST
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City | MIAMI
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State | FL
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Zip | 33173-2309
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Country | US
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Telephone | 305-496-0011
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT19316
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License Number State | FL
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