Provider Demographics
NPI:1508082413
Name:TATE, NAYDAMAR (LMT)
Entity Type:Individual
Prefix:
First Name:NAYDAMAR
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 E CENTRAL PKWY
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-3402
Mailing Address - Country:US
Mailing Address - Phone:407-299-0646
Mailing Address - Fax:407-299-6914
Practice Address - Street 1:499 E CENTRAL PKWY
Practice Address - Street 2:SUITE 115
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-3402
Practice Address - Country:US
Practice Address - Phone:407-299-0646
Practice Address - Fax:407-299-6914
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA49084225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist