Provider Demographics
NPI:1497010631
Name:LASTIMOSA, EMILY ALMENDRA (PT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ALMENDRA
Last Name:LASTIMOSA
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:UNIT 2008
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6314
Mailing Address - Country:US
Mailing Address - Phone:561-496-7993
Mailing Address - Fax:561-496-0589
Practice Address - Street 1:16089 POPPYSEED CIR
Practice Address - Street 2:UNIT 2008
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6314
Practice Address - Country:US
Practice Address - Phone:561-496-7993
Practice Address - Fax:561-496-0589
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070018418225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist