Provider Demographics
NPI:1669637997
Name:MIAMI SPORST MASSAGE CENTER
Entity Type:Organization
Organization Name:MIAMI SPORST MASSAGE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MASSAGE THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:NORDLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-409-0532
Mailing Address - Street 1:11537 SW 81ST RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-4414
Mailing Address - Country:US
Mailing Address - Phone:305-409-0532
Mailing Address - Fax:
Practice Address - Street 1:11537 SW 81 ROAD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156
Practice Address - Country:US
Practice Address - Phone:305-409-0532
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-25
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMT0000006640302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization