Provider Demographics
NPI:1578998316
Name:LOMBARDO, VICKY A (PTA)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:A
Last Name:LOMBARDO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 SE PARKVIEW PL
Mailing Address - Street 2:H-7
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-5411
Mailing Address - Country:US
Mailing Address - Phone:772-634-1007
Mailing Address - Fax:
Practice Address - Street 1:1271 SE PARKVIEW PL
Practice Address - Street 2:H-7
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-5411
Practice Address - Country:US
Practice Address - Phone:772-634-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23556225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant