Provider Demographics
NPI:1922835644
Name:LIMA PINEDA, JESUS JAVIER (PTA)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:JAVIER
Last Name:LIMA PINEDA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 SW 98TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2942
Mailing Address - Country:US
Mailing Address - Phone:786-222-1484
Mailing Address - Fax:
Practice Address - Street 1:4960 SW 72ND AVE STE 408
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5506
Practice Address - Country:US
Practice Address - Phone:786-351-6799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-17
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33671225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant