Provider Demographics
NPI:1093223083
Name:TORRES, ROLANDO SR (LMT)
Entity Type:Individual
Prefix:
First Name:ROLANDO
Middle Name:
Last Name:TORRES
Suffix:SR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 W 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-3009
Mailing Address - Country:US
Mailing Address - Phone:786-306-2032
Mailing Address - Fax:786-999-8234
Practice Address - Street 1:1513 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-3009
Practice Address - Country:US
Practice Address - Phone:786-306-2032
Practice Address - Fax:786-999-8234
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2018-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
FLMA67157225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016612000Medicaid