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General NPI Number Information
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NPI Number | 1164707832
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Entity Type | Organization
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Legal Business Name | MIRACLE MASSAGE AND REHAB CORP
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Dates
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Enumeration Date | 10/13/2011
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Last Update Date | 10/13/2011
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Provider Practice Location Address
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Address Line | 624 E 9TH ST
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City | HIALEAH
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State | FL
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Zip | 33010-4552
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Country | US
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Telephone | 305-887-8701
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Fax | 305-887-8705
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Provider Business Mailing Address
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Address Line | 624 E 9TH ST
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City | HIALEAH
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State | FL
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Zip | 33010-4552
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Country | US
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Telephone | 305-887-8701
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Fax | 305-887-8705
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Authorized Official
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Title or Position | OWNER
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Name | ANYELEY MESA
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Credential | MA 61548
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Telephone | 305-887-8701
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173C00000X
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Taxonomy Name | Reflexologist
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License Number | MA 61548
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License Number State | FL
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