MEDICARE: LILIANA ILLESCAS 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 38750	FL

General Provider Information

NPI Number	:	1487798575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LILIANA ILLESCAS LMT

Provider Business Mailing Address
First Line	:	14900 SW 43RD ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4381
Country	:	US
Telephone Number	:	305-528-8544
Fax Number	:	305-448-3882

Provider Business Practice Location Address
First Line	:	14900 SW 43RD ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4381
Country	:	US
Telephone Number	:	305-528-8544
Fax Number	:	305-448-3882

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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