Active NPI
Aida Sofia Montenegro, PTA
- Physical Therapy Assistant
- Pembroke Pines, FL
National Provider Identifier
1396614269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA34363
- 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, 2025
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PTA34363 | Other | FL | LICENSE |
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
| License | State | Type | Specialty |
|---|---|---|---|
| PTA34363 | FL | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bolanos Associates, LLC. | Past | 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.
-
- Multi-Specialty Clinic/Center
- Miami, FL
- NPI 1427288851
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.