MEDICARE: ALEJANDRO MONTIEL MASSAGE THERAPIST

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	MA23857	FL

General Provider Information

NPI Number	:	1417563065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEJANDRO MONTIEL MASSAGE THERAPIST

Provider Business Mailing Address
First Line	:	2050 NE 140TH ST APT 22
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33181-1653
Country	:	US
Telephone Number	:	305-409-6554
Fax Number	:

Provider Business Practice Location Address
First Line	:	2050 NE 140TH ST APT 22
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33181-1653
Country	:	US
Telephone Number	:	305-409-6554
Fax Number	:

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

Provider Enumeration Date	:	09/18/2020
Last Update Date	:	09/18/2020

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Directions to “ ALEJANDRO MONTIEL MASSAGE THERAPIST” Practice Location

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