Provider Demographics
NPI:1609932565
Name:FARRETTA, ANDREW RYAN (LMT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:RYAN
Last Name:FARRETTA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9850 STIRLING RD
Mailing Address - Street 2:STE #102
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-8068
Mailing Address - Country:US
Mailing Address - Phone:954-434-1990
Mailing Address - Fax:954-433-4475
Practice Address - Street 1:9850 STIRLING RD
Practice Address - Street 2:STE #102
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-8068
Practice Address - Country:US
Practice Address - Phone:954-434-1990
Practice Address - Fax:954-433-4475
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43967225700000X
FLAP3017171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP3017OtherACUPUNCTURIST LICENSE