Provider Demographics
NPI:1104932847
Name:MENDIETA, ANA M (MSPT)
Entity type:Individual
Prefix:MS
First Name:ANA
Middle Name:M
Last Name:MENDIETA
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7600 SW 57 AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143
Mailing Address - Country:US
Mailing Address - Phone:305-740-7292
Mailing Address - Fax:305-328-6624
Practice Address - Street 1:7800 SW 57TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5544
Practice Address - Country:US
Practice Address - Phone:305-740-7292
Practice Address - Fax:305-328-6624
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2018-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT6315225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885450500Medicaid
FLY5851OtherBCBS OF FLORIDA
FLY5851OtherBCBS OF FLORIDA