Provider Demographics
NPI:1235425539
Name:ROBSHAM, LYDIE
Entity Type:Individual
Prefix:MRS
First Name:LYDIE
Middle Name:
Last Name:ROBSHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LYDIE
Other - Middle Name:
Other - Last Name:ROBSHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:2708 LAKE OSBORNE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-5665
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2708 LAKE OSBORNE DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-5665
Practice Address - Country:US
Practice Address - Phone:561-856-0131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA29544225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC1070OtherBLUE CROSS BLUE SHIELD