Provider Demographics
NPI:1669974952
Name:ALVARO, MICHIE ANTONIA (LMT)
Entity type:Individual
Prefix:
First Name:MICHIE
Middle Name:ANTONIA
Last Name:ALVARO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10820 NE 11TH CT
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-7310
Mailing Address - Country:US
Mailing Address - Phone:954-871-4077
Mailing Address - Fax:
Practice Address - Street 1:10820 NE 11TH CT
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-7310
Practice Address - Country:US
Practice Address - Phone:954-871-4077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA79419225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty