Provider Demographics
NPI:1366918005
Name:YISRAEL, TIRZAH MILCAH (LMT)
Entity type:Individual
Prefix:MRS
First Name:TIRZAH
Middle Name:MILCAH
Last Name:YISRAEL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 NE 167TH ST STE 318
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33162-2441
Mailing Address - Country:US
Mailing Address - Phone:786-444-5292
Mailing Address - Fax:
Practice Address - Street 1:633 NE 167TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33162-2442
Practice Address - Country:US
Practice Address - Phone:786-444-5292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-20
Last Update Date:2018-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA85196225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist