Provider Demographics
NPI:1629780846
Name:MACH, JUDITH ROXANA (LMT)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ROXANA
Last Name:MACH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:ROXANA
Other - Last Name:MACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:3000 N OCEAN BLVD APT 402
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-7326
Mailing Address - Country:US
Mailing Address - Phone:954-471-6446
Mailing Address - Fax:
Practice Address - Street 1:1507 E LAS OLAS BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-2345
Practice Address - Country:US
Practice Address - Phone:954-471-6446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL99240225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist