MEDICARE: MR. JOHN HARRY AVILES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MA18443	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MA18443	OTHER	FL	MASSAGE LICENSE NUMBER

General Provider Information

NPI Number	:	1083237135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN HARRY AVILES

Provider Business Mailing Address
First Line	:	14453 SW 172ND LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-6619
Country	:	US
Telephone Number	:	786-295-1905
Fax Number	:

Provider Business Practice Location Address
First Line	:	14453 SW 172ND LN
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33177-6619
Country	:	US
Telephone Number	:	786-295-1905
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2020
Last Update Date	:	05/23/2020

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Directions to “ MR. JOHN HARRY AVILES ” Practice Location

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