Provider Demographics
NPI:1871127696
Name:NIETO BORJA, ESTHER (LMT)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:NIETO BORJA
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 1:2009 CLIPPER TER
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-5332
Mailing Address - Country:US
Mailing Address - Phone:239-247-2578
Mailing Address - Fax:
Practice Address - Street 1:462 E COWBOY WAY STE 4
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-4445
Practice Address - Country:US
Practice Address - Phone:863-234-3372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA93605225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist