Provider Demographics
NPI:1932407145
Name:TEIJEIRO, JUAN MANUEL (LMT)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:MANUEL
Last Name:TEIJEIRO
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 NW 79TH AVE STE 324
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6547
Mailing Address - Country:US
Mailing Address - Phone:305-310-1606
Mailing Address - Fax:
Practice Address - Street 1:3900 NW 79TH AVE STE 324
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6547
Practice Address - Country:US
Practice Address - Phone:305-310-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48466225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist