Provider Demographics
NPI:1245616424
Name:PICARD, LYDIA (PT, DPT)
Entity Type:Individual
Prefix:MISS
First Name:LYDIA
Middle Name:
Last Name:PICARD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 WOODEN MILL TER
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-5553
Mailing Address - Country:US
Mailing Address - Phone:561-762-9462
Mailing Address - Fax:
Practice Address - Street 1:210 JUPITER LAKES BLVD
Practice Address - Street 2:SUITE 5101
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7191
Practice Address - Country:US
Practice Address - Phone:561-741-1876
Practice Address - Fax:888-721-1997
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 29454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist