Provider Demographics
NPI:1427403559
Name:IGNACIO, ALBERT (LMT, CMMP)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:
Last Name:IGNACIO
Suffix:
Gender:M
Credentials:LMT, CMMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W MAIN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507-1640
Mailing Address - Country:US
Mailing Address - Phone:859-443-4292
Mailing Address - Fax:502-808-6074
Practice Address - Street 1:401 W MAIN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507-1640
Practice Address - Country:US
Practice Address - Phone:859-443-4292
Practice Address - Fax:502-808-6074
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0574225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist