MEDICARE: DYLAN ALEXANDER OTERO 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	1165	PR

General Provider Information

NPI Number	:	1376409581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYLAN ALEXANDER OTERO LMT

Provider Business Mailing Address
First Line	:	911 CALLE DUKE
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00927-4814
Country	:	US
Telephone Number	:	787-639-1281
Fax Number	:

Provider Business Practice Location Address
First Line	:	911 CALLE DUKE
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00927-4814
Country	:	US
Telephone Number	:	787-639-1281
Fax Number	:

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

Provider Enumeration Date	:	12/31/2025
Last Update Date	:	12/31/2025

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