Provider Demographics
NPI:1699062331
Name:AGUIAR, JERRY III (PTA 39)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:AGUIAR
Suffix:III
Gender:M
Credentials:PTA 39
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 350312
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-0312
Mailing Address - Country:US
Mailing Address - Phone:786-290-4600
Mailing Address - Fax:305-631-8177
Practice Address - Street 1:1393 SW 1 ST STE 415
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-2321
Practice Address - Country:US
Practice Address - Phone:786-290-4600
Practice Address - Fax:305-631-8177
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 39225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant