Provider Demographics
NPI:1700600079
Name:MACCHIO, ELMIRA
Entity type:Individual
Prefix:
First Name:ELMIRA
Middle Name:
Last Name:MACCHIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4226 HELENA ST NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-5451
Mailing Address - Country:US
Mailing Address - Phone:727-710-2783
Mailing Address - Fax:
Practice Address - Street 1:5100 W KENNEDY BLVD STE 280
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-1892
Practice Address - Country:US
Practice Address - Phone:813-819-1955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-13
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA33754225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant