MEDICARE: PRIDA MAYLOR DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT20499	FL

General Provider Information

NPI Number	:	1366747941
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRIDA MAYLOR DPT

Provider Business Mailing Address
First Line	:	2962 SW 26TH TERRACE
Second Line	:	SUITE 105
City	:	DANIA BEACH
State	:	FL
Zip	:	33312
Country	:	US
Telephone Number	:	305-333-4254
Fax Number	:

Provider Business Practice Location Address
First Line	:	2962 SW 26TH TERRACE
Second Line	:	SUITE 105
City	:	DANIA BEACH
State	:	FL
Zip	:	33312
Country	:	US
Telephone Number	:	305-333-4254
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2011
Last Update Date	:	01/13/2011

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