Individual
LUCY MAYORGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
311 NE 8TH ST STE 104, HOMESTEAD, FL 33030-4734
(305) 245-0356
Mailing address
311 NE 8TH ST STE 104, HOMESTEAD, FL 33030-4734
(305) 245-0356
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
21865
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21865
PTA FL LICENSE
FL
Enumeration date
10/03/2013
Last updated
10/03/2013
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