MEDICARE: MRS. MELINDA TUBERA PRADO PT

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	13146	NC

General Provider Information

NPI Number	:	1952697393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELINDA TUBERA PRADO PT

Provider Business Mailing Address
First Line	:	720 WINSLOW STREET
Second Line	:
City	:	HERTFORD
State	:	NC
Zip	:	27944
Country	:	US
Telephone Number	:	954-999-3728
Fax Number	:	954-942-1130

Provider Business Practice Location Address
First Line	:	925 S SEMORAN BLVD
Second Line	:	108
City	:	WINTER PARK
State	:	FL
Zip	:	32792-5313
Country	:	US
Telephone Number	:	877-430-2772
Fax Number	:	800-521-9608

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

Provider Enumeration Date	:	06/23/2011
Last Update Date	:	09/13/2012

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