Provider Demographics
NPI:1497031462
Name:MONTALVAN, EDDY (LMT)
Entity Type:Individual
Prefix:MR
First Name:EDDY
Middle Name:
Last Name:MONTALVAN
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 1:18210 MEDITERRANEAN BLVD
Mailing Address - Street 2:APT 2004
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-5759
Mailing Address - Country:US
Mailing Address - Phone:305-721-8296
Mailing Address - Fax:305-384-4835
Practice Address - Street 1:18210 MEDITERRANEAN BLVD
Practice Address - Street 2:APT 2004
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5759
Practice Address - Country:US
Practice Address - Phone:305-721-8296
Practice Address - Fax:305-384-4835
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-22
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL50925225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist