Provider Demographics
NPI:1578757092
Name:MONTOYA ROMERO, JORGE (LMT)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:MONTOYA ROMERO
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 1:9708 POPULAR ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33635-5919
Mailing Address - Country:US
Mailing Address - Phone:813-610-3072
Mailing Address - Fax:
Practice Address - Street 1:9708 POPULAR ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33635-5919
Practice Address - Country:US
Practice Address - Phone:813-610-3072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA53560225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist