Provider Demographics
NPI:1013241157
Name:TESALONA, EMILIANO D JR (LMT)
Entity type:Individual
Prefix:MR
First Name:EMILIANO
Middle Name:D
Last Name:TESALONA
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
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Mailing Address - Street 1:162 NW SWANN MILL CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3592
Mailing Address - Country:US
Mailing Address - Phone:772-285-5403
Mailing Address - Fax:772-345-4979
Practice Address - Street 1:162 NW SWANN MILL CIR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3592
Practice Address - Country:US
Practice Address - Phone:772-285-5403
Practice Address - Fax:772-345-4979
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA15944172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist