Provider Demographics
NPI:1891531299
Name:REYES, MARCELA (LMT)
Entity type:Individual
Prefix:
First Name:MARCELA
Middle Name:
Last Name:REYES
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 1:2900 NW 42ND AVE APT 109
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-2170
Mailing Address - Country:US
Mailing Address - Phone:954-871-8425
Mailing Address - Fax:
Practice Address - Street 1:5850 CORAL RIDGE DR STE 314
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33076-3380
Practice Address - Country:US
Practice Address - Phone:917-450-1976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-04
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA104965225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty