Provider Demographics
NPI:1073847984
Name:SWEET, DAMIAN LAMAR (LMT)
Entity Type:Individual
Prefix:
First Name:DAMIAN
Middle Name:LAMAR
Last Name:SWEET
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6225 N DALE MABRY HWY
Mailing Address - Street 2:APT 1203
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-3983
Mailing Address - Country:US
Mailing Address - Phone:813-770-6658
Mailing Address - Fax:
Practice Address - Street 1:1037 W BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7703
Practice Address - Country:US
Practice Address - Phone:813-868-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA57036225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist