MEDICARE: JUAN JULIO SANTANA 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	MA 60415	FL

General Provider Information

NPI Number	:	1306144043
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN JULIO SANTANA LMT

Provider Business Mailing Address
First Line	:	PO BOX 830846
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33283-0846
Country	:	US
Telephone Number	:	786-339-3584
Fax Number	:

Provider Business Practice Location Address
First Line	:	7044 SW 114TH PL
Second Line	:	UNIT A
City	:	MIAMI
State	:	FL
Zip	:	33173-1854
Country	:	US
Telephone Number	:	786-339-3584
Fax Number	:

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

Provider Enumeration Date	:	03/04/2011
Last Update Date	:	03/04/2011

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