Provider Demographics
NPI:1710201785
Name:MIRACLE MASSAGE & THERAPY CENTER, INC
Entity Type:Organization
Organization Name:MIRACLE MASSAGE & THERAPY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:239-692-8591
Mailing Address - Street 1:13260 IMMOKALEE RD STE 2
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-1788
Mailing Address - Country:US
Mailing Address - Phone:239-692-8591
Mailing Address - Fax:239-692-8594
Practice Address - Street 1:13260 IMMOKALEE RD STE 2
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34120-1788
Practice Address - Country:US
Practice Address - Phone:239-692-8591
Practice Address - Fax:239-692-8594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-19
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM24538261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center