Provider Demographics
NPI:1518123801
Name:BARRY, MICHAEL J (LMT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:BARRY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:MR
Other - First Name:JAI
Other - Middle Name:MICHAEL
Other - Last Name:BARRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:1207 KENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2420
Mailing Address - Country:US
Mailing Address - Phone:321-438-3726
Mailing Address - Fax:
Practice Address - Street 1:200 N DENNING DR
Practice Address - Street 2:#9
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3736
Practice Address - Country:US
Practice Address - Phone:321-438-3726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA48973225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist