Provider Demographics
NPI:1629407408
Name:VIDAL, LILIANA (LMT)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:VIDAL
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 1:2926 ROYAL PALM AVE
Mailing Address - Street 2:APTO 1
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-4382
Mailing Address - Country:US
Mailing Address - Phone:305-343-2646
Mailing Address - Fax:
Practice Address - Street 1:2926 ROYAL PALM AVE APT 1
Practice Address - Street 2:APTO 1
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-4342
Practice Address - Country:US
Practice Address - Phone:305-343-2646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA46089225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist