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3595 W 20th Ave Ste 115 Hialeah FL 33012-4533 | |
| (305) 570-1666 | |
| (305) 203-0546 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 3595 W 20th Ave Ste 115, Hialeah, Florida |
| Authorized Official Name and Position | Donna Lea Fonda (CREDENTIALING DIRECTOR) |
| Authorized Official Contact | 3054709399 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
12277 Sw 130th St Miami FL 33186-6218 Ph: (305) 470-3399 | 3595 W 20th Ave Ste 115 Hialeah FL 33012-4533 Ph: (305) 570-1666 |
| NPI Number | 1063177483 |
|---|---|
| Provider Enumeration Date | 11/01/2021 |
| Last Update Date | 01/25/2024 |
| Medicare PECOS PAC ID | 4880035906 |
|---|---|
| Medicare Enrollment ID | O20240507002988 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063177483 | NPI | - | NPPES |
| OT11471 | Other | FL | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Andres F Zapata |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1750328316 PECOS PAC ID: 1759357726 Enrollment ID: I20040909001378 |
| Provider Name | Gaspara Barditch |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1760653661 PECOS PAC ID: 5395816326 Enrollment ID: I20080619000306 |
| Provider Name | Maureen L Moder |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1679541262 PECOS PAC ID: 4284957879 Enrollment ID: I20150107001193 |
| Provider Name | Karina L Gass |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1063941367 PECOS PAC ID: 5496167876 Enrollment ID: I20201208002141 |
| Provider Name | Thomas H Pineiro |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1265023212 PECOS PAC ID: 5991110256 Enrollment ID: I20210218000936 |
| Provider Name | Kai S Brown |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1942737952 PECOS PAC ID: 1759659501 Enrollment ID: I20210324002235 |
| Provider Name | Melissa G Delasota |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1346823713 PECOS PAC ID: 9133528599 Enrollment ID: I20210604001509 |
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