Provider Demographics
NPI:1629623467
Name:D'ANDREA, JOSEPH A JR (LMT)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:A
Last Name:D'ANDREA
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:MR
Other - First Name:JOE
Other - Middle Name:
Other - Last Name:D'ANDREA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:667 SUN RAY CT
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-1822
Mailing Address - Country:US
Mailing Address - Phone:561-895-4709
Mailing Address - Fax:
Practice Address - Street 1:667 SUN RAY CT
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-1822
Practice Address - Country:US
Practice Address - Phone:561-895-4709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-08
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007635225700000X
FLMA96420225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist