Healthcare Provider Details

I. General information

NPI: 1356930259
Provider Name (Legal Business Name): JUAN CARLOS AGOSTO LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2021
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

A5 CALLE 1 STE 4
CAGUAS PR
00725-2492
US

IV. Provider business mailing address

PO BOX 29974
SAN JUAN PR
00929-0974
US

V. Phone/Fax

Practice location:
  • Phone: 787-228-8063
  • Fax:
Mailing address:
  • Phone: 787-413-0002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number1190
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: