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General NPI Number Information
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NPI Number | 1447570635
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Entity Type | Individual
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Provider Name | ANDREA MACHADO L.M.T., M.M.R
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Gender | Female
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 06/10/2010
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Provider Practice Location Address
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Address Line | 2815 W NEW HAVEN AVE STE 302
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City | W MELBOURNE
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State | FL
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Zip | 32904-3655
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Country | US
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Telephone | 321-725-0073
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Fax |
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Provider Business Mailing Address
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Address Line | 951 BELLEVUE ST NE
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City | PALM BAY
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State | FL
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Zip | 32907-5533
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Country | US
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Telephone | 321-795-0519
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 36407
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License Number State | FL
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