1154554699 NPI number — MARIA LALU CARLSWARD L.M.T.

Table of content: MARIA LALU CARLSWARD L.M.T. (NPI 1154554699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154554699 NPI number — MARIA LALU CARLSWARD L.M.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARLSWARD
Provider First Name:
MARIA
Provider Middle Name:
LALU
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.M.T.
Provider Gender Code:
F

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:
1154554699
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14920 NW 16 DR
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:
33167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-863-3391
Provider Business Mailing Address Fax Number:
305-681-8419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
570 OCEAN DR.
Provider Second Line Business Practice Location Address:
#501
Provider Business Practice Location Address City Name:
JUNO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-491-2225
Provider Business Practice Location Address Fax Number:
954-491-6862
Provider Enumeration Date:
09/01/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MA44687 . This is a "LICENSED MASSAGE THERAPIST" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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