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General NPI Number Information
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NPI Number | 1699038992
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Entity Type | Individual
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Provider Name | JUDITH MOURINO MECHANO THERAPIST
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Gender | Female
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Dates
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Enumeration Date | 06/21/2012
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Last Update Date | 06/21/2012
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Provider Practice Location Address
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Address Line | 9369 FOUNTAINBLEU BLVD
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City | MIAMI
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State | FL
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Zip | 33172
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Country | US
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Telephone | 786-970-2542
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Fax | 786-275-4132
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Provider Business Mailing Address
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Address Line | 9369 FOUNTAINBLEAU BLVD
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City | MIAMI
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State | FL
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Zip | 33172-5686
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Country | US
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Telephone | 786-970-2542
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Fax | 786-275-4132
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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 | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | MA65381
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License Number State | FL
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