Provider Demographics
NPI:1003232109
Name:HEALTH FOR LIFE MASSAGE THERAPY
Entity Type:Organization
Organization Name:HEALTH FOR LIFE MASSAGE THERAPY
Other - Org Name:HEALTH FOR LIFE MASSAGE THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:YENIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:I
Authorized Official - Credentials:OWNER
Authorized Official - Phone:786-360-1613
Mailing Address - Street 1:4160 W 16TH AVE
Mailing Address - Street 2:SUITE#305
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5853
Mailing Address - Country:US
Mailing Address - Phone:786-237-5541
Mailing Address - Fax:768-360-1614
Practice Address - Street 1:4160 W 16TH AVE
Practice Address - Street 2:SUITE#305
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5853
Practice Address - Country:US
Practice Address - Phone:786-237-5541
Practice Address - Fax:768-360-1614
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH FOR LIFE MASSAGE THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC11126261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC11126OtherHEALTH CARE CLINIC