Provider Demographics
NPI:1174325757
Name:MANSOUR, MENA K (PT, DPT)
Entity type:Individual
Prefix:
First Name:MENA
Middle Name:K
Last Name:MANSOUR
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 LAKEVIEW DR STE 1081
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2056
Mailing Address - Country:US
Mailing Address - Phone:407-850-8489
Mailing Address - Fax:
Practice Address - Street 1:2915 LAKEVIEW DR STE 1081
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2056
Practice Address - Country:US
Practice Address - Phone:407-850-8489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37668225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist