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General NPI Number Information
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NPI Number | 1881999159
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Entity Type | Individual
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Provider Name | ANDREA L MALECKI LMT
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Gender | Female
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 01/18/2011
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Provider Practice Location Address
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Address Line | 3404 S ATLANTIC AVE
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-3626
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Country | US
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Telephone | 386-405-4820
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Fax |
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Provider Business Mailing Address
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Address Line | 217 HUBBELL ST
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City | EDGEWATER
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State | FL
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Zip | 32132-1701
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Country | US
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Telephone | 386-405-4820
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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 | MA58870
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License Number State | FL
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