Provider Demographics
NPI:1043884935
Name:FERREYRA, MARCELO (LMT)
Entity Type:Individual
Prefix:
First Name:MARCELO
Middle Name:
Last Name:FERREYRA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17492
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33318-7492
Mailing Address - Country:US
Mailing Address - Phone:305-213-6566
Mailing Address - Fax:
Practice Address - Street 1:6100 HOLLYWOOD BLVD
Practice Address - Street 2:STE 104
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-7991
Practice Address - Country:US
Practice Address - Phone:305-213-6566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA89423225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist