Provider Demographics
NPI:1558930701
Name:CONAT, LYNETTE K
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:K
Last Name:CONAT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3753 46TH AVE S APT 10
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-4460
Mailing Address - Country:US
Mailing Address - Phone:727-424-1410
Mailing Address - Fax:
Practice Address - Street 1:3753 46TH AVE S # AAPT10
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-4400
Practice Address - Country:US
Practice Address - Phone:727-424-1410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-22
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL47593225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty