Healthcare Provider Details

I. General information

NPI: 1578708442
Provider Name (Legal Business Name): MICHAEL ANDAYA P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2008
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 REGENCY SQUARE
VERO BEACH FL
32967
US

IV. Provider business mailing address

1155 8TH PLACE
VERO FL
32960-2143
US

V. Phone/Fax

Practice location:
  • Phone: 772-794-9524
  • Fax:
Mailing address:
  • Phone: 772-567-9327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number20505
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: