Provider Demographics
NPI:1861475501
Name:MACHUPA, NICHOLAS F (PT)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:F
Last Name:MACHUPA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 SW 19TH AVENUE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-1391
Mailing Address - Country:US
Mailing Address - Phone:352-237-4133
Mailing Address - Fax:352-873-4581
Practice Address - Street 1:2135 SW 19TH AVENUE RD STE 103
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-7877
Practice Address - Country:US
Practice Address - Phone:352-237-4133
Practice Address - Fax:352-873-4581
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2358225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY4563YMedicare PIN