Healthcare Provider Details

I. General information

NPI: 1073891842
Provider Name (Legal Business Name): ABELARDO BARRETO MASSSAGE THERAPIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 07/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 W 29TH ST 5
HIALEAH FL
33012-5736
US

IV. Provider business mailing address

50 W 29TH ST 5
HIALEAH FL
33012-5736
US

V. Phone/Fax

Practice location:
  • Phone: 305-960-7678
  • Fax: 305-675-2668
Mailing address:
  • Phone: 305-960-7678
  • Fax: 305-675-2668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA62684
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: