Provider Demographics
NPI:1407130818
Name:CALLEROS, SILVIA MERCEDEZ (LMT)
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:MERCEDEZ
Last Name:CALLEROS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MISS
Other - First Name:MERCEDEZ
Other - Middle Name:
Other - Last Name:CALLEROS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:54 HARRY KEMP WAY
Mailing Address - Street 2:UNIT 1
Mailing Address - City:PROVINCETOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02657-1619
Mailing Address - Country:US
Mailing Address - Phone:774-722-0295
Mailing Address - Fax:866-571-0419
Practice Address - Street 1:54 HARRY KEMP WAY
Practice Address - Street 2:UNIT 1
Practice Address - City:PROVINCETOWN
Practice Address - State:MA
Practice Address - Zip Code:02657-1619
Practice Address - Country:US
Practice Address - Phone:774-722-0295
Practice Address - Fax:866-571-0419
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-04
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3347225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist