Individual provider Active NPI

Mylene A Moreno, PT

  • Specialist
  • Miami Beach, FL
National Provider Identifier
1669605333
Registry record updated Sep 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
16672 Issued in FL
Practice address
1330 West Ave Apt 1911
Miami Beach, FL 33139-0908
Phone
(305) 604-8051
Fax
(305) 604-8051
NPI assigned
Aug 28, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 16672 FL Primary

Addresses

Primary practice location

1330 West Ave Apt 1911
Miami Beach, FL 33139-0908

Mailing address

1330 West Ave Apt 1911
Miami Beach, FL 33139-0908
Phone (305) 604-8051

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210817002939 FL Practitioner - Physical Therapist in Private Practice 3678978491 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

6840 SW 40TH St
Suite 210
Miami, FL 33155-3756
Phone (305) 599-0911

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
16672FLMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Florida Luna Care Physical Therapy LLC CurrentSince Jul 30, 2021 Accepting new patients
Physical Therapy Now Holdings, LLC PastSince Feb 15, 2023 Accepting new patients

Locations

5011 Gate Pkwy
Ste 100
Jacksonville, FL 32256
Phone (904) 326-3627

Organizations & group practices 3

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": "1251417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346889600000",
    "number": "1669605333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1330 WEST AVE APT 1911",
            "city": "MIAMI BEACH",
            "state": "FL",
            "postal_code": "331390908",
            "telephone_number": "305-604-8051",
            "fax_number": "305-604-8051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1330 WEST AVE APT 1911",
            "city": "MIAMI BEACH",
            "state": "FL",
            "postal_code": "331390908",
            "telephone_number": "305-604-8051",
            "fax_number": "305-604-8051"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MORENO",
        "first_name": "MYLENE",
        "middle_name": "A",
        "name_prefix": "Miss",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-28",
        "last_updated": "2012-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "FL",
            "license": "16672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.