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General NPI Number Information
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NPI Number | 1235414624
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL MASSAGE& THERAPHY INC.
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Dates
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Enumeration Date | 10/17/2011
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Last Update Date | 10/17/2011
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Provider Practice Location Address
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Address Line | 2611 SW 26TH LN
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City | MIAMI
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State | FL
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Zip | 33133-2233
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Country | US
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Telephone | 786-715-3130
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Fax |
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Provider Business Mailing Address
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Address Line | 2611 SW 26TH LN
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City | MIAMI
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State | FL
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Zip | 33133-2233
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Country | US
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Telephone | 786-715-3130
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPHY
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Name | OSCAR FIANDOR
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Credential | MA
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Telephone | 786-715-3130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA 57646
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License Number State | FL
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