Provider Demographics
NPI:1235414624
Name:PROFESSIONAL MASSAGE& THERAPHY INC.
Entity Type:Organization
Organization Name:PROFESSIONAL MASSAGE& THERAPHY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPHY
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:FIANDOR
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:786-715-3130
Mailing Address - Street 1:2611 SW 26TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2233
Mailing Address - Country:US
Mailing Address - Phone:786-715-3130
Mailing Address - Fax:
Practice Address - Street 1:2611 SW 26TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2233
Practice Address - Country:US
Practice Address - Phone:786-715-3130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 57646225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL03/03/1969OtherB.O.D