Provider Demographics
NPI:1376144162
Name:MASSA, MICHAELA NICHOLE
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:NICHOLE
Last Name:MASSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 JOSHUA DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-2248
Mailing Address - Country:US
Mailing Address - Phone:702-752-9803
Mailing Address - Fax:
Practice Address - Street 1:338 VETERANS MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36082-7729
Practice Address - Country:US
Practice Address - Phone:334-670-3452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26912255A2300X
2255A2300X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program