Provider Demographics
NPI:1619175965
Name:MOLINEROS, ASTRID (PTA)
Entity type:Individual
Prefix:MRS
First Name:ASTRID
Middle Name:
Last Name:MOLINEROS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10861 NW 34TH PL
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-7071
Mailing Address - Country:US
Mailing Address - Phone:954-227-7164
Mailing Address - Fax:
Practice Address - Street 1:7447 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2970
Practice Address - Country:US
Practice Address - Phone:954-720-1530
Practice Address - Fax:954-720-6540
Is Sole Proprietor?:No
Enumeration Date:2007-07-09
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 20873225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant