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General NPI Number Information
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NPI Number | 1356634257
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Entity Type | Organization
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Legal Business Name | B&M PROFESSIONAL THERAPEUTIC MASSAGE CORP.
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Dates
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Enumeration Date | 05/25/2011
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 7124 SW 114TH PL APT G
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City | MIAMI
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State | FL
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Zip | 33173-1885
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Country | US
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Telephone | 786-291-1803
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Fax |
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Provider Business Mailing Address
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Address Line | 1421 SW 107TH AVE # 220
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City | MIAMI
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State | FL
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Zip | 33174-2526
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Country | US
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Telephone | 786-291-1803
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Fax |
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Authorized Official
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Title or Position | MASSAGE THERAPIST
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Name | MR. BENIGNO PENA
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Credential | MASSAGE THERAPIST
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Telephone | 786-291-1803
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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 | MA62320
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License Number State | FL
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