Provider Demographics
NPI:1316383755
Name:TAMPOCO, LOVELLE PALOMENO (PT)
Entity Type:Individual
Prefix:
First Name:LOVELLE
Middle Name:PALOMENO
Last Name:TAMPOCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16089 POPPYSEED CIR
Mailing Address - Street 2:SUITE 2008
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6314
Mailing Address - Country:US
Mailing Address - Phone:772-418-6346
Mailing Address - Fax:
Practice Address - Street 1:16089 POPPYSEED CIR
Practice Address - Street 2:SUITE 2008
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6314
Practice Address - Country:US
Practice Address - Phone:772-418-6346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-13
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23065225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist