Provider Demographics
NPI:1003826736
Name:APOLLO MEDICAL MASSAGE, INC.
Entity Type:Organization
Organization Name:APOLLO MEDICAL MASSAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-676-5600
Mailing Address - Street 1:551 S APOLLO BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-1274
Mailing Address - Country:US
Mailing Address - Phone:321-259-8226
Mailing Address - Fax:321-951-8162
Practice Address - Street 1:551 S APOLLO BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1274
Practice Address - Country:US
Practice Address - Phone:321-259-8226
Practice Address - Fax:321-951-8162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM14612173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMM14612OtherMASSAGE LICENSE