Provider Demographics
NPI:1780118372
Name:MEDICO MASSAGE THERAPY
Entity type:Organization
Organization Name:MEDICO MASSAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MASSAGE THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:J
Authorized Official - Last Name:JARAMILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MT
Authorized Official - Phone:305-650-1942
Mailing Address - Street 1:17064 W DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3723
Mailing Address - Country:US
Mailing Address - Phone:305-650-1942
Mailing Address - Fax:
Practice Address - Street 1:571 NW 153RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33169-6623
Practice Address - Country:US
Practice Address - Phone:786-738-4634
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty