Provider Demographics
NPI:1679334890
Name:CONSUEGRA, KEILA (LMT)
Entity type:Individual
Prefix:
First Name:KEILA
Middle Name:
Last Name:CONSUEGRA
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 1:4283 OAK TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3716
Mailing Address - Country:US
Mailing Address - Phone:201-927-6707
Mailing Address - Fax:
Practice Address - Street 1:4283 OAK TERRACE DR
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3716
Practice Address - Country:US
Practice Address - Phone:201-927-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA100424225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist