Provider Demographics
NPI:1134713225
Name:ALESSANDRO MUKNICKA, LLC
Entity type:Organization
Organization Name:ALESSANDRO MUKNICKA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALESSANDRO
Authorized Official - Middle Name:ALPHA
Authorized Official - Last Name:MUKNICKA
Authorized Official - Suffix:
Authorized Official - Credentials:LMT,CPT
Authorized Official - Phone:352-246-8429
Mailing Address - Street 1:4408 NW 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7215
Mailing Address - Country:US
Mailing Address - Phone:352-246-8429
Mailing Address - Fax:
Practice Address - Street 1:4408 NW 36TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7215
Practice Address - Country:US
Practice Address - Phone:352-246-8429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-01
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty