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General NPI Number Information
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NPI Number | 1821430190
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Entity Type | Individual
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Provider Name | ANDRE MERCADO PTA
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Gender | Male
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Dates
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Enumeration Date | 07/26/2013
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Last Update Date | 07/26/2013
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Provider Practice Location Address
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Address Line | 10794 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33026-3920
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Country | US
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Telephone | 954-447-2423
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Fax |
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Provider Business Mailing Address
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Address Line | 2233 SW 34TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33312-4341
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Country | US
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Telephone | 305-335-2616
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA 23618
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License Number State | FL
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