MEDICARE: JOSE DANIEL FERNANDEZ LMT

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 71145	FL

General Provider Information

NPI Number	:	1376980607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE DANIEL FERNANDEZ LMT

Provider Business Mailing Address
First Line	:	135 W 32ND ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5422
Country	:	US
Telephone Number	:	786-457-2216
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 W 32ND ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5422
Country	:	US
Telephone Number	:	786-457-2216
Fax Number	:

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

Provider Enumeration Date	:	05/28/2013
Last Update Date	:	05/28/2013

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