Provider Demographics
NPI:1861776197
Name:MORFA DIAZ, IVON MILAGROS (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MS
First Name:IVON
Middle Name:MILAGROS
Last Name:MORFA DIAZ
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:8750 GLADIOLUS DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4165
Mailing Address - Country:US
Mailing Address - Phone:239-689-5738
Mailing Address - Fax:
Practice Address - Street 1:8750 GLADIOLUS DR
Practice Address - Street 2:SUITE 5
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4165
Practice Address - Country:US
Practice Address - Phone:239-689-5738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA64922225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist