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General NPI Number Information
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NPI Number | 1962623967
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Entity Type | Individual
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Provider Name | JOHN MASSA M.S. CCC-SLP
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1611 NW 12TH AVE TRA 491
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City | MIAMI
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State | FL
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Zip | 33136-1005
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Country | US
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Telephone | 305-585-1260
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Fax | 305-585-1183
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Provider Business Mailing Address
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Address Line | 15225 NW 4TH ST
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1802
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Country | US
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Telephone | 954-438-7586
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Fax | 954-438-7586
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA 3224
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License Number State | FL
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