Provider Demographics
NPI:1134439730
Name:LIBERTO, THOMAS (LMT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:LIBERTO
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 1:1123 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-2353
Mailing Address - Country:US
Mailing Address - Phone:561-582-2306
Mailing Address - Fax:561-582-2307
Practice Address - Street 1:1123 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-2353
Practice Address - Country:US
Practice Address - Phone:561-582-2306
Practice Address - Fax:561-582-2307
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0003690225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist