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NPI Code Detail

MEDICARE: TIFFANY BALTIERO LMT LLC

MEDICARE: TIFFANY BALTIERO LMT LLC
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
1225700000XMassage Therapist

General Provider Information

NPI Number : 1588126205
Entity Type Code : Organization
Provider Name (Legal Business Name) : TIFFANY BALTIERO LMT LLC
Provider Business Mailing Address
First Line : 1286 MENNA ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32205-8330
Country : US
Telephone Number : 904-405-8260
Fax Number :
Provider Business Practice Location Address
First Line : 2523 HERSCHEL ST
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32204-4509
Country : US
Telephone Number : 904-405-8260
Fax Number :
Authorized Official
Title or Position : OWNER/OPERATOR
Name : TIFFANY BALTIERO
Credential : LMT
Telephone Number : 904-405-8260
Provider Enumeration Date : 04/02/2019
Last Update Date : 04/02/2019

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