Provider Demographics
NPI:1265979652
Name:CAMESA, ANDRO POL SUAREZ (PT)
Entity type:Individual
Prefix:MR
First Name:ANDRO POL
Middle Name:SUAREZ
Last Name:CAMESA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 SAWGRASS CORPORATE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2869
Mailing Address - Country:US
Mailing Address - Phone:954-739-4247
Mailing Address - Fax:
Practice Address - Street 1:160 NE CONIFER BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4162
Practice Address - Country:US
Practice Address - Phone:541-757-1651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR62088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist