Provider Demographics
NPI:1740974054
Name:TORRUELLA-THILLET, CARMEN MILAGROS (LMT/CMT)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:MILAGROS
Last Name:TORRUELLA-THILLET
Suffix:
Gender:F
Credentials:LMT/CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PONTE VEDRA CT UNIT B
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-1733
Mailing Address - Country:US
Mailing Address - Phone:904-955-6468
Mailing Address - Fax:
Practice Address - Street 1:3 PONTE VEDRA CT UNIT B
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-1733
Practice Address - Country:US
Practice Address - Phone:904-955-6468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-08
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA101966225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist