Provider Demographics
NPI:1609124072
Name:MASSEY, MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MASSEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2595 TAMPA RD STE U
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3132
Mailing Address - Country:US
Mailing Address - Phone:727-238-3238
Mailing Address - Fax:727-382-8186
Practice Address - Street 1:2595 TAMPA RD STE U
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3132
Practice Address - Country:US
Practice Address - Phone:727-238-3238
Practice Address - Fax:727-382-8186
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.060829208100000X
IL036133901208100000X
MN611312081P2900X
FLOS171962081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation