Provider Demographics
NPI:1376865410
Name:FIRESTAR, ADELE (MA)
Entity Type:Individual
Prefix:MS
First Name:ADELE
Middle Name:
Last Name:FIRESTAR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7076 DEMEDICI CIR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-3184
Mailing Address - Country:US
Mailing Address - Phone:561-573-0445
Mailing Address - Fax:954-363-7497
Practice Address - Street 1:1000 E HILLSBORO BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-3628
Practice Address - Country:US
Practice Address - Phone:954-363-7494
Practice Address - Fax:954-363-7497
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA35649225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA35649OtherSTATE LICENSE