| Doctor Name: | MRS. MAUREEN LEE MODER |
| NPI Number: | 1679541262 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MS, PT |
| License Number: | 0006317 |
| Business Practice Address: | 6341 Sunset Dr South Miami, FL - 331434842 |
| Business Phone Number: | 3056625924 |
| Business Fax Number: | 3056634442 |
| Mailing Address: | 7900 Sw 161st St, VILLAGE OF PALMETTO BAY |
| State: | FL |
| Postal Code: | 331573737 |
| Phone Number: | 3052556869 |
| Fax Number: | |
| NPI Enumeration Date: | 03/09/2006 |
| NPI Last Update Date: | 10/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 0006317 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |