Provider Demographics
NPI:1831456706
Name:CRAS-BETANCOURT, EDISLEYDI (MASSAGE THERAPY)
Entity type:Individual
Prefix:MS
First Name:EDISLEYDI
Middle Name:
Last Name:CRAS-BETANCOURT
Suffix:
Gender:F
Credentials:MASSAGE THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1853 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1903
Mailing Address - Country:US
Mailing Address - Phone:786-399-0563
Mailing Address - Fax:
Practice Address - Street 1:1853 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1903
Practice Address - Country:US
Practice Address - Phone:786-399-0563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA62801225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist