Provider Demographics
NPI:1639795792
Name:MCGILL, NADRIAN (LMT)
Entity Type:Individual
Prefix:
First Name:NADRIAN
Middle Name:
Last Name:MCGILL
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 SAIL HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-1840
Mailing Address - Country:US
Mailing Address - Phone:407-706-4783
Mailing Address - Fax:
Practice Address - Street 1:3633 SAIL HARBOR DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-1840
Practice Address - Country:US
Practice Address - Phone:407-706-4783
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA88100225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist