Provider Demographics
NPI:1417613100
Name:HANNA TEJEDA, EDER Z (LMT)
Entity Type:Individual
Prefix:
First Name:EDER
Middle Name:Z
Last Name:HANNA TEJEDA
Suffix:
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 1:3350 SW ESCAROLE ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-3499
Mailing Address - Country:US
Mailing Address - Phone:561-577-6079
Mailing Address - Fax:
Practice Address - Street 1:3350 SW ESCAROLE ST
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-3499
Practice Address - Country:US
Practice Address - Phone:561-577-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA93173225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist