Provider Demographics
NPI:1659840742
Name:MASSAGE MIAMI PRO INC
Entity Type:Organization
Organization Name:MASSAGE MIAMI PRO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:786-973-0167
Mailing Address - Street 1:8315 W FLAGLER ST STE 27
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2029
Mailing Address - Country:US
Mailing Address - Phone:786-973-0167
Mailing Address - Fax:
Practice Address - Street 1:8315 W FLAGLER ST STE 27
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2029
Practice Address - Country:US
Practice Address - Phone:786-973-0167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty