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General NPI Number Information
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NPI Number | 1114224318
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Entity Type | Individual
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Provider Name | JAVIER MARTIN MASSAGE THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 175 FONTAINEBLEAU BLVD STE 2D1
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City | MIAMI
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State | FL
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Zip | 33172-7013
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Country | US
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Telephone | 305-227-8088
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Fax | 305-227-8089
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Provider Business Mailing Address
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Address Line | 175 FONTAINEBLEAU BLVD STE 2D1
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City | MIAMI
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State | FL
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Zip | 33172-7013
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Country | US
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Telephone | 305-227-8088
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Fax | 305-227-8089
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | MA 59190
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License Number State | FL
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