Provider Demographics
NPI:1841659000
Name:MURDOCCA, MARISA (LMT)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:MURDOCCA
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 1:3610 MONT MARTRE DR APT 1184
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-3171
Mailing Address - Country:US
Mailing Address - Phone:863-409-7855
Mailing Address - Fax:
Practice Address - Street 1:933 LEWIS DR
Practice Address - Street 2:SUITE B
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2261
Practice Address - Country:US
Practice Address - Phone:863-409-7855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 73557225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist