Individual provider Active NPI

Aida Sofia Montenegro, PTA

  • Physical Therapy Assistant
  • Pembroke Pines, FL
National Provider Identifier
1396614269
Registry record updated Oct 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
PTA34363 Issued in FL
Practice address
111 Grand Palms Dr
Pembroke Pines, FL 33027-1329
Phone
(786) 259-0300
Fax
(866) 665-8671
NPI assigned
Oct 30, 2025
Last updated
Oct 30, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 30, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X PTA34363 FL Primary

Addresses

Primary practice location

111 Grand Palms Dr
Pembroke Pines, FL 33027-1329

Mailing address

15751 Sheridan St # 303
Fort Lauderdale, FL 33331-3486
Phone (786) 259-0300

Other practice location 1

7340 NW 5th St
Plantation, FL 33317-1605
Phone (786) 259-0300

Other identifiers 1

IdentifierTypeStateIssuer
PTA34363OtherFLLICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PTA34363FLMDPhysical Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bolanos Associates, LLC. PastSince Aug 14, 2025 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1761782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761782400000",
    "number": "1396614269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15751 SHERIDAN ST # 303",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333313486",
            "telephone_number": "786-259-0300",
            "fax_number": "866-665-8671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 GRAND PALMS DR",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330271329",
            "telephone_number": "786-259-0300",
            "fax_number": "866-665-8671"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7340 NW 5th St",
            "address_purpose": "LOCATION",
            "city": "Plantation",
            "state": "FL",
            "postal_code": "333171605",
            "country_code": "US",
            "telephone_number": "786-259-0300",
            "fax_number": "866-665-8671",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MONTENEGRO",
        "first_name": "AIDA",
        "middle_name": "SOFIA",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-10-30",
        "last_updated": "2025-10-30",
        "certification_date": "2025-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA34363",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "PTA34363",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pembroke Pines, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.