Provider Demographics
NPI:1194741140
Name:MEJIA, LUIS C (PT)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:C
Last Name:MEJIA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3729 FALCON RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-5021
Mailing Address - Country:US
Mailing Address - Phone:954-632-8535
Mailing Address - Fax:954-659-0584
Practice Address - Street 1:3729 FALCON RIDGE CIR
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-5021
Practice Address - Country:US
Practice Address - Phone:954-632-8535
Practice Address - Fax:954-659-0584
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2009-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20330225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU4925WMedicare PIN
FLU4925ZMedicare ID - Type Unspecified