Provider Demographics
NPI:1508017450
Name:LOIS-REITOR, MIRTA (LMT)
Entity Type:Individual
Prefix:
First Name:MIRTA
Middle Name:
Last Name:LOIS-REITOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12650 SW 15TH ST APT F105
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2179
Mailing Address - Country:US
Mailing Address - Phone:954-290-0609
Mailing Address - Fax:954-441-5231
Practice Address - Street 1:12650 SW 15TH ST APT F105
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-2179
Practice Address - Country:US
Practice Address - Phone:954-290-0609
Practice Address - Fax:954-441-5231
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 44761225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist