1972894632 NPI number — DORAMEL THERAPY & SPA, LLC

Table of content: (NPI 1972894632)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972894632 NPI number — DORAMEL THERAPY & SPA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DORAMEL THERAPY & SPA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972894632
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2780 SW 87TH AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33165-3296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2780 SW 87TH AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33165-3296
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-222-2281
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DIAZ
Authorized Official First Name:
DORA
Authorized Official Middle Name:
Authorized Official Title or Position:
MASSAGE THERAPIST
Authorized Official Telephone Number:
305-222-2281

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  ME90883 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X , with the licence number: PT1857 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: MA37303 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA9100070 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)