Provider Demographics
NPI:1487188322
Name:PARRA, JUAN PABLO (LMT)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:PABLO
Last Name:PARRA
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 1:10336 FOX TRAIL RD S APT 1314
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-1435
Mailing Address - Country:US
Mailing Address - Phone:561-907-2732
Mailing Address - Fax:
Practice Address - Street 1:10336 FOX TRAIL RD S APT 1314
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-1435
Practice Address - Country:US
Practice Address - Phone:561-907-2732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA83831225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist