Provider Demographics
NPI:1568575546
Name:LORMIL, KATHLEEN (LMT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:LORMIL
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 1:548 HEARTHGLEN BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4524
Mailing Address - Country:US
Mailing Address - Phone:407-949-1106
Mailing Address - Fax:407-614-4573
Practice Address - Street 1:548 HEARTHGLEN BLVD
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4524
Practice Address - Country:US
Practice Address - Phone:407-949-1106
Practice Address - Fax:407-614-4573
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA34943225700000X
FLPT34943225100000X, 2251N0400X, 2251X0800X
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684561496Medicaid