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General NPI Number Information
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NPI Number | 1386925444
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Entity Type | Individual
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Provider Name | ALEXANDER MIRON
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Gender | Male
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Dates
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Enumeration Date | 09/02/2011
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Last Update Date | 08/13/2012
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Provider Practice Location Address
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Address Line | 3660 CENTRAL AVE SUITE # 7
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City | FORT MYERS
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State | FL
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Zip | 33901-7699
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Country | US
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Telephone | 239-931-5292
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Fax | 239-931-5302
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Provider Business Mailing Address
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Address Line | 3660 CENTRAL AVE SUITE # 7
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City | FORT MYERS
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State | FL
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Zip | 33901-7699
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Country | US
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Telephone | 239-931-5292
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Fax | 239-931-5302
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA63547
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License Number State | FL
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