Edward Gonzalo Reyes Caceres, MA94672

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MA94672 Issued in FL

Practice address

6551 Arleigh CT Apt 107
Boca Raton, FL 33433-7856

Phone

(754) 249-3626

NPI assigned

Nov 20, 2020

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1605830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605830400000",
    "number": "1306449269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6551 ARLEIGH CT APT 107",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334337856",
            "telephone_number": "754-249-3626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6551 ARLEIGH CT APT 107",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334337856",
            "telephone_number": "754-249-3626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "REYES CACERES",
        "first_name": "EDWARD",
        "middle_name": "GONZALO",
        "name_prefix": "Mr.",
        "credential": "MA94672",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-11-20",
        "last_updated": "2020-11-20",
        "certification_date": "2020-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "FL",
            "license": "MA94672",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martha Lorena Revollo, M.D.
• Revolution Physical Therapy, LLC
• Jessica Revord, BCBA
• Kelly Lauren Reyer, PHARMD
• Mark Reyer, M.D.
• Eneilitza Ivelisse Reyes Mendoza
• Lory Reyes, PHD
• Nancy Reyes
• Rita R Reyes, OTR
• Lourdes Reynolds, PT

• Massage Therapist in Boca Raton, FL
• Providers in Boca Raton, FL by specialty
• Massage Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.