Provider Demographics
NPI:1871008243
Name:MILLOT, SANDRA (MASSAGE THERAPIST MA)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:MILLOT
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9009 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6440
Mailing Address - Country:US
Mailing Address - Phone:954-438-4000
Mailing Address - Fax:
Practice Address - Street 1:9009 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6440
Practice Address - Country:US
Practice Address - Phone:954-438-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-07
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51245225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA51245OtherMASSAGE THERAPIST