Provider Demographics
NPI:1063872125
Name:LUENGAS, MA BLESS FRETSY TAJALE
Entity type:Individual
Prefix:MISS
First Name:MA BLESS FRETSY
Middle Name:TAJALE
Last Name:LUENGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 W SAMPLE RD APT 206
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-3238
Mailing Address - Country:US
Mailing Address - Phone:954-345-7040
Mailing Address - Fax:
Practice Address - Street 1:5800 W SAMPLE RD APT 206
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3238
Practice Address - Country:US
Practice Address - Phone:954-345-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-02
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070022004225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist