Provider Demographics
NPI:1205039617
Name:LUNDY, EMILY C (LMT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:C
Last Name:LUNDY
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 1:2896 EDGEHILL LN
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3773
Mailing Address - Country:US
Mailing Address - Phone:954-296-3386
Mailing Address - Fax:
Practice Address - Street 1:2896 EDGEHILL LN
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33026-3773
Practice Address - Country:US
Practice Address - Phone:954-296-3386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 44153171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor