Healthcare Provider Details

I. General information

NPI: 1144970567
Provider Name (Legal Business Name): FRANKLIN ANTHONY PANIAGUA JR. LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4925 SHERIDAN ST
HOLLYWOOD FL
33021-2834
US

IV. Provider business mailing address

2541 ARAGON BLVD APT 107
SUNRISE FL
33322-3101
US

V. Phone/Fax

Practice location:
  • Phone: 954-438-4000
  • Fax:
Mailing address:
  • Phone: 954-839-7993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA79318
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: