Provider Demographics
NPI:1033601307
Name:MUSCLE SPECIFIC PAIN MANAGEMENT CENTER
Entity Type:Organization
Organization Name:MUSCLE SPECIFIC PAIN MANAGEMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL MASSAGE PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:ALEXI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MMP
Authorized Official - Phone:305-290-1440
Mailing Address - Street 1:1011 W HALLANDALE BEACH BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5278
Mailing Address - Country:US
Mailing Address - Phone:305-290-1440
Mailing Address - Fax:
Practice Address - Street 1:1011 W HALLANDALE BEACH BLVD STE 108
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5278
Practice Address - Country:US
Practice Address - Phone:305-290-1440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-03
Last Update Date:2018-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL33893261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center