Provider Demographics
NPI:1710262092
Name:GLOBAL MASSAGE & THERAPY CENTER CORP
Entity Type:Organization
Organization Name:GLOBAL MASSAGE & THERAPY CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YUDEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRANDA PEREDA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:239-540-0124
Mailing Address - Street 1:1105 CAPE CORAL PKWY E STE B
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-9175
Mailing Address - Country:US
Mailing Address - Phone:239-540-0124
Mailing Address - Fax:239-540-0502
Practice Address - Street 1:1105 CAPE CORAL PKWY E STE B
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-9175
Practice Address - Country:US
Practice Address - Phone:239-540-0124
Practice Address - Fax:239-540-0502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1972806370OtherMASSAGE THERAPY