MEDICARE: MS. JUDITH ROXANA MACH LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	99240	FL

General Provider Information

NPI Number	:	1629780846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUDITH ROXANA MACH LMT

Provider Business Mailing Address
First Line	:	3000 N OCEAN BLVD APT 402
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-7326
Country	:	US
Telephone Number	:	954-471-6446
Fax Number	:

Provider Business Practice Location Address
First Line	:	1507 E LAS OLAS BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2345
Country	:	US
Telephone Number	:	954-471-6446
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2022
Last Update Date	:	12/19/2022

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