MEDICARE: PERLA HERRERA PERLA HERRERA 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	44532	FL

General Provider Information

NPI Number	:	1558681783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERLA HERRERA PERLA HERRERA L.M.T

Provider Business Mailing Address
First Line	:	14465 SW 138TH PL
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-7216
Country	:	US
Telephone Number	:	305-321-3890
Fax Number	:

Provider Business Practice Location Address
First Line	:	1450 CORAL WAY
Second Line	:	# 4
City	:	MIAMI
State	:	FL
Zip	:	33145-2856
Country	:	US
Telephone Number	:	305-446-7250
Fax Number	:

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

Provider Enumeration Date	:	06/10/2010
Last Update Date	:	06/10/2010

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