MEDICARE: LISSETTE ACEBAL

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	MA:63291	FL

General Provider Information

NPI Number	:	1255675120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISSETTE ACEBAL

Provider Business Mailing Address
First Line	:	14750 SW 26TH ST STE 114
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5934
Country	:	US
Telephone Number	:	786-308-7153
Fax Number	:

Provider Business Practice Location Address
First Line	:	14750 SW 26TH ST STE 114
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5934
Country	:	US
Telephone Number	:	786-308-7153
Fax Number	:

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

Provider Enumeration Date	:	11/16/2012
Last Update Date	:	12/17/2012

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Directions to “ LISSETTE ACEBAL ” Practice Location

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