Provider Demographics
NPI:1356484885
Name:LAMBETH, PATRICK JOHN (PTA)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:JOHN
Last Name:LAMBETH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 SMOKEMONT CT
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-1477
Mailing Address - Country:US
Mailing Address - Phone:407-963-4260
Mailing Address - Fax:
Practice Address - Street 1:934 WILLISTON PARK PT
Practice Address - Street 2:SUITE 1020
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2165
Practice Address - Country:US
Practice Address - Phone:407-829-7311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 13652225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant