Healthcare Provider Details

I. General information

NPI: 1376144162
Provider Name (Legal Business Name): MICHAELA NICHOLE MASSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 VETERANS MEMORIAL DRIVE
TROY AL
36082-7729
US

IV. Provider business mailing address

995 JOSHUA DR
RENO NV
89509-2248
US

V. Phone/Fax

Practice location:
  • Phone: 334-670-3452
  • Fax:
Mailing address:
  • Phone: 702-752-9803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2691
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: