Provider Demographics
NPI:1669789988
Name:HERNANDEZ ACOSTA, MAYKEL (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:MAYKEL
Middle Name:
Last Name:HERNANDEZ ACOSTA
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8045 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6627
Mailing Address - Country:US
Mailing Address - Phone:305-594-1757
Mailing Address - Fax:305-594-9781
Practice Address - Street 1:8045 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6627
Practice Address - Country:US
Practice Address - Phone:305-594-1757
Practice Address - Fax:305-594-9781
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA58826261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy