Provider Demographics
NPI:1376715037
Name:MACHADO, MARCELO (LMT)
Entity Type:Individual
Prefix:
First Name:MARCELO
Middle Name:
Last Name:MACHADO
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 1:5137 ARBOR GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-8044
Mailing Address - Country:US
Mailing Address - Phone:561-255-2960
Mailing Address - Fax:
Practice Address - Street 1:2605 E ATLANTIC BLVD STE 200
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-4948
Practice Address - Country:US
Practice Address - Phone:561-255-2960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 44562172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist