Provider Demographics
NPI:1023316544
Name:SANCHEZ, PORTHOS DANIEL (LMT)
Entity type:Individual
Prefix:MR
First Name:PORTHOS
Middle Name:DANIEL
Last Name:SANCHEZ
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 1:725 84TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-1158
Mailing Address - Country:US
Mailing Address - Phone:305-861-1504
Mailing Address - Fax:
Practice Address - Street 1:725 84TH ST APT 1
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33141-1158
Practice Address - Country:US
Practice Address - Phone:305-861-1504
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL61978225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist