Provider Demographics
NPI:1295868107
Name:CALANDRO, MARK ANTHONY (CNMT, LMT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:CALANDRO
Suffix:
Gender:M
Credentials:CNMT, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28469 US HIGHWAY 19 N
Mailing Address - Street 2:SUITE 402 & 404
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-2512
Mailing Address - Country:US
Mailing Address - Phone:727-723-3888
Mailing Address - Fax:727-796-2888
Practice Address - Street 1:28469 US HIGHWAY 19 N
Practice Address - Street 2:SUITE 402 & 404
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-2512
Practice Address - Country:US
Practice Address - Phone:727-723-3888
Practice Address - Fax:727-796-2888
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 5125225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist