Provider Demographics
NPI:1841419405
Name:CALANDRILLO, MICHAEL (MPT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:CALANDRILLO
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1548 SW 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-7209
Mailing Address - Country:US
Mailing Address - Phone:561-859-3030
Mailing Address - Fax:561-347-6007
Practice Address - Street 1:5130 LINTON BLVD STE G2
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6597
Practice Address - Country:US
Practice Address - Phone:561-495-9880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY001ROtherBCBS PROVIDER NUMBER
FLY9399ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER