MEDICARE: MRS. RAFAEL A CORPORAN LMT

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	MA72217	FL

General Provider Information

NPI Number	:	1104400670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RAFAEL A CORPORAN LMT

Provider Business Mailing Address
First Line	:	2800 SW 38TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33134-7348
Country	:	US
Telephone Number	:	214-434-5050
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 SW 38TH CT
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33134-7348
Country	:	US
Telephone Number	:	214-434-5050
Fax Number	:

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

Provider Enumeration Date	:	05/10/2021
Last Update Date	:	05/10/2021

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