Provider Demographics
NPI:1578708442
Name:ANDAYA, MICHAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:ANDAYA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 8TH PLACE
Mailing Address - Street 2:
Mailing Address - City:VERO
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2143
Mailing Address - Country:US
Mailing Address - Phone:772-567-9327
Mailing Address - Fax:
Practice Address - Street 1:910 REGENCY SQUARE
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32967
Practice Address - Country:US
Practice Address - Phone:772-794-9524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-08
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL205052251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT-20505OtherPT LICENSE