Provider Demographics
NPI:1972269058
Name:AITA, CARLOS ADOLFO (LMT)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:ADOLFO
Last Name:AITA
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 1:8356 SW 40TH ST STE L
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3356
Mailing Address - Country:US
Mailing Address - Phone:305-228-6400
Mailing Address - Fax:
Practice Address - Street 1:8356 SW 40TH ST STE L
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3356
Practice Address - Country:US
Practice Address - Phone:305-228-6400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA67162225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist