Doctor Name: | MICHELLE L MANDICH |
NPI Number: | 1134422173 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LMT |
License Number: | MA51120 |
Business Practice Address: | 3636 Del Prado Blvd S. Cape Coral, FL - 33904 |
Business Phone Number: | 2395405560 |
Business Fax Number: | 2395400270 |
Mailing Address: | 3636 Del Prado Blvd S., CAPE CORAL |
State: | FL |
Postal Code: | 33904 |
Phone Number: | 2395405560 |
Fax Number: | 2395400270 |
NPI Enumeration Date: | 12/14/2010 |
NPI Last Update Date: | 12/20/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 225700000X |
License Number: | MA51120 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Massage Therapist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |