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General NPI Number Information
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NPI Number | 1073927448
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Entity Type | Organization
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Legal Business Name | LDL MASSAGEE, INC.
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Dates
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Enumeration Date | 06/13/2014
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Last Update Date | 06/13/2014
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Provider Practice Location Address
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Address Line | 815 NW 57TH AVE STE 125
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City | MIAMI
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State | FL
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Zip | 33126-2068
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Country | US
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Telephone | 305-901-1687
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Fax |
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Provider Business Mailing Address
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Address Line | 815 NW 57TH AVE STE 125
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City | MIAMI
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State | FL
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Zip | 33126-2068
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Country | US
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Telephone | 305-901-1687
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Fax |
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Authorized Official
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Title or Position | PRESIDENTE
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Name | LEIDY DIAS
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Credential | LMT
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Telephone | 305-901-1687
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | MA62062
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License Number State | FL
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