Provider Demographics
NPI:1396371993
Name:AGUILERA, EDMEE (LMT)
Entity Type:Individual
Prefix:
First Name:EDMEE
Middle Name:
Last Name:AGUILERA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2314 DEL PRADO BLVD S STE 2
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-6635
Mailing Address - Country:US
Mailing Address - Phone:239-347-3965
Mailing Address - Fax:
Practice Address - Street 1:2314 DEL PRADO BLVD S STE 2
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-6635
Practice Address - Country:US
Practice Address - Phone:239-347-3965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA82243225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist