Provider Demographics
NPI:1639964877
Name:KFOURI CRISPINO, RENATO (LMT)
Entity type:Individual
Prefix:MR
First Name:RENATO
Middle Name:
Last Name:KFOURI CRISPINO
Suffix:
Gender:
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 SW 12TH ST APT 207
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33130-4553
Mailing Address - Country:US
Mailing Address - Phone:772-333-1752
Mailing Address - Fax:
Practice Address - Street 1:221 SW 12TH ST APT 207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-4553
Practice Address - Country:US
Practice Address - Phone:772-333-1752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA104646225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist