Provider Demographics
NPI:1477764124
Name:MAYORAL, HECTOR (LMT)
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:
Last Name:MAYORAL
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 1:156 DOUGLAS RD W
Mailing Address - Street 2:# D
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2830
Mailing Address - Country:US
Mailing Address - Phone:727-376-8144
Mailing Address - Fax:
Practice Address - Street 1:3314 W COLUMBUS DR
Practice Address - Street 2:STE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-1801
Practice Address - Country:US
Practice Address - Phone:813-341-5100
Practice Address - Fax:813-341-5101
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 37895225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist