Provider Demographics
NPI:1306452891
Name:ROLDAN-APONTE, LUIS MANUEL (LMT)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:MANUEL
Last Name:ROLDAN-APONTE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16733 NW 167TH DR
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-6498
Mailing Address - Country:US
Mailing Address - Phone:352-328-7210
Mailing Address - Fax:
Practice Address - Street 1:16733 NW 167TH DR
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-6498
Practice Address - Country:US
Practice Address - Phone:352-328-7210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-20
Last Update Date:2020-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA89848225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist