Provider Demographics
NPI:1639412182
Name:LLERA, ROY ALEXANDER (LMT)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:ALEXANDER
Last Name:LLERA
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 1:249 CERTOSA AVE NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-3228
Mailing Address - Country:US
Mailing Address - Phone:321-634-2067
Mailing Address - Fax:
Practice Address - Street 1:18 W AVENUE B
Practice Address - Street 2:SUITE 2
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1219
Practice Address - Country:US
Practice Address - Phone:321-634-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA57119225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist