Provider Demographics
NPI:1649598582
Name:LUNDQUIST, NIKI LIN
Entity Type:Individual
Prefix:
First Name:NIKI
Middle Name:LIN
Last Name:LUNDQUIST
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:PO BOX 692321
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32869-2321
Mailing Address - Country:US
Mailing Address - Phone:407-260-2883
Mailing Address - Fax:
Practice Address - Street 1:4190 S KIRKMAN RD
Practice Address - Street 2:APT. 909
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-2854
Practice Address - Country:US
Practice Address - Phone:407-260-2883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-15
Last Update Date:2010-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225600000X
FLMA25773225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225600000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDance Therapist