Provider Demographics
NPI:1073964029
Name:PINERA, MONICA (PTA26566)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:PINERA
Suffix:
Gender:F
Credentials:PTA26566
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4913 WISHART BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-1616
Mailing Address - Country:US
Mailing Address - Phone:813-452-9948
Mailing Address - Fax:
Practice Address - Street 1:162 W ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5112
Practice Address - Country:US
Practice Address - Phone:813-230-3514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26566225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant