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General NPI Number Information
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NPI Number | 1104164383
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Entity Type | Organization
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Legal Business Name | THERAPEUTIC MASSAGE SERVICES OF OKEECHOBEE ROAD CORP
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Dates
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Enumeration Date | 01/23/2013
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Last Update Date | 01/23/2013
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Provider Practice Location Address
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Address Line | 8040 NW 95TH ST SUITE 223
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City | HIALEAH GARDENS
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State | FL
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Zip | 33016-2361
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Country | US
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Telephone | 305-200-1311
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Fax | 305-200-1316
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Provider Business Mailing Address
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Address Line | 8040 NW 95TH ST SUITE 223
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City | HIALEAH GARDENS
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State | FL
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Zip | 33016-2361
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Country | US
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Telephone | 305-200-1311
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Fax | 305-200-1316
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Authorized Official
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Title or Position | PRESIDENT
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Name | REINALDO CINTA GONZALEZ
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Credential | MA64005
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Telephone | 305-200-1311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number | HCC9905
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License Number State | FL
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