Provider Demographics
NPI:1730899683
Name:COUTURE, ANDRE
Entity type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:
Last Name:COUTURE
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 1:2439 POLK ST APT 6
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4335
Mailing Address - Country:US
Mailing Address - Phone:786-879-4002
Mailing Address - Fax:
Practice Address - Street 1:2439 POLK ST APT 6
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4335
Practice Address - Country:US
Practice Address - Phone:786-879-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA51977225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist