MEDICARE: LUZ DANEIRA CHAVES MA 57033

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

General Provider Information

NPI Number	:	1063027431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUZ DANEIRA CHAVES MA 57033

Provider Business Mailing Address
First Line	:	10126 NW 3RD PL
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6807
Country	:	US
Telephone Number	:	954-552-9054
Fax Number	:

Provider Business Practice Location Address
First Line	:	10126 NW 3RD PL
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-6807
Country	:	US
Telephone Number	:	954-552-9054
Fax Number	:

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

Provider Enumeration Date	:	09/12/2020
Last Update Date	:	09/12/2020

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