Provider Demographics
NPI:1679667869
Name:MASEDA-LOPEZ, JEANETTE (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:
Last Name:MASEDA-LOPEZ
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9231 SW 66TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-2309
Mailing Address - Country:US
Mailing Address - Phone:305-496-0011
Mailing Address - Fax:
Practice Address - Street 1:2500 E HALLANDALE BEACH BLVD STE 611
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-4853
Practice Address - Country:US
Practice Address - Phone:954-454-2345
Practice Address - Fax:954-457-8242
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist