Provider Demographics
NPI:1568744191
Name:S & B MASSAGE THERAPY
Entity Type:Organization
Organization Name:S & B MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NICANOR
Authorized Official - Middle Name:
Authorized Official - Last Name:HAIDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:786-228-9490
Mailing Address - Street 1:2711 SW 137TH AVE STE 83
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6360
Mailing Address - Country:US
Mailing Address - Phone:786-228-9490
Mailing Address - Fax:305-647-6404
Practice Address - Street 1:2711 SW 137TH AVE STE 83
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6360
Practice Address - Country:US
Practice Address - Phone:786-228-9490
Practice Address - Fax:305-647-6404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA61028225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty