Provider Demographics
NPI:1285151498
Name:MEZA, RONALD (DPT, PT, ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:MEZA
Suffix:
Gender:M
Credentials:DPT, PT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11058 FAIRHAVEN WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7110
Mailing Address - Country:US
Mailing Address - Phone:201-870-7879
Mailing Address - Fax:
Practice Address - Street 1:3451 TECHNOLOGICAL AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-8353
Practice Address - Country:US
Practice Address - Phone:407-681-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
FL42672255A2300X
FL38355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4267OtherATHLETIC TRAINING LICENSE
FL38355OtherPHYSICAL THERAPY