Healthcare Provider Details

I. General information

NPI: 1386939361
Provider Name (Legal Business Name): LY THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2011
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 WESTWARD DR
MIAMI SPRINGS FL
33166-5256
US

IV. Provider business mailing address

70 WESTWARD DR
MIAMI SPRINGS FL
33166-5256
US

V. Phone/Fax

Practice location:
  • Phone: 786-401-7046
  • Fax: 786-536-5635
Mailing address:
  • Phone: 786-401-7046
  • Fax: 786-536-5635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License NumberMM27011
License Number State

VIII. Authorized Official

Name: MARISLEIDY CABRERA
Title or Position: OWNER
Credential: LMT
Phone: 786-401-7046