Provider Demographics
NPI:1558604769
Name:AGOADO, ANDREW (LAC, LMT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:AGOADO
Suffix:
Gender:M
Credentials:LAC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 CLINT MOORE RD
Mailing Address - Street 2:SUITE #182
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2768
Mailing Address - Country:US
Mailing Address - Phone:561-988-1998
Mailing Address - Fax:561-988-8944
Practice Address - Street 1:1601 CLINT MOORE RD
Practice Address - Street 2:SUITE #182
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2768
Practice Address - Country:US
Practice Address - Phone:561-988-1998
Practice Address - Fax:561-988-8944
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-05
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3220171100000X
FLMA68681225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist