Provider Demographics
NPI:1851525596
Name:MIRABAL, ALFREDO (LMT)
Entity Type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:
Last Name:MIRABAL
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 1:4706 LUCERNE LAKES BLVD E
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-8875
Mailing Address - Country:US
Mailing Address - Phone:561-201-4345
Mailing Address - Fax:
Practice Address - Street 1:4748 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-7951
Practice Address - Country:US
Practice Address - Phone:561-642-6118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-10
Last Update Date:2009-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0019176225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist