Provider Demographics
NPI:1912762170
Name:MACHULSKI, ANDREAS
Entity Type:Individual
Prefix:
First Name:ANDREAS
Middle Name:
Last Name:MACHULSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5882 PALMER RANCH PARKWAY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238
Mailing Address - Country:US
Mailing Address - Phone:941-284-5451
Mailing Address - Fax:
Practice Address - Street 1:333 TAMIAMI TRL S STE 207
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2424
Practice Address - Country:US
Practice Address - Phone:941-484-2471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25356225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant