MEDICARE: ERIKA MARIE REYES L.M.T.

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	MA56305	FL

General Provider Information

NPI Number	:	1083998033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA MARIE REYES L.M.T.

Provider Business Mailing Address
First Line	:	PO BOX 28302
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33002-8302
Country	:	US
Telephone Number	:	786-319-6490
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 W 59TH PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2307
Country	:	US
Telephone Number	:	786-319-6490
Fax Number	:

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

Provider Enumeration Date	:	10/07/2011
Last Update Date	:	10/07/2011

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