MEDICARE: MR. JORGE PORTO MASSAGE THERAPIST MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA62203	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA62203	OTHER	FL	MASSAGE THERAPIST

General Provider Information

NPI Number	:	1053826438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JORGE PORTO MASSAGE THERAPIST MA

Provider Business Mailing Address
First Line	:	1422 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3700
Country	:	US
Telephone Number	:	305-631-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	1422 NW 7TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-3700
Country	:	US
Telephone Number	:	305-631-8080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2017
Last Update Date	:	12/07/2017

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Directions to “ MR. JORGE PORTO MASSAGE THERAPIST MA” Practice Location

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