Healthcare Provider Details

I. General information

NPI: 1003826736
Provider Name (Legal Business Name): APOLLO MEDICAL MASSAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 S APOLLO BLVD SUITE 205
MELBOURNE FL
32901-1274
US

IV. Provider business mailing address

551 S APOLLO BLVD SUITE 205
MELBOURNE FL
32901-1274
US

V. Phone/Fax

Practice location:
  • Phone: 321-259-8226
  • Fax: 321-951-8162
Mailing address:
  • Phone: 321-259-8226
  • Fax: 321-951-8162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMM14612
License Number StateFL

VIII. Authorized Official

Name: MRS. MARY CATHERINE BERGER
Title or Position: OFFICE MANAGER
Credential:
Phone: 321-676-5600