Provider Demographics
NPI:1710421789
Name:SMITH, LYNDON II (LMT)
Entity Type:Individual
Prefix:
First Name:LYNDON
Middle Name:
Last Name:SMITH
Suffix:II
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 45TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2929
Mailing Address - Country:US
Mailing Address - Phone:561-801-8002
Mailing Address - Fax:561-844-4166
Practice Address - Street 1:717 45TH ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2929
Practice Address - Country:US
Practice Address - Phone:561-801-8002
Practice Address - Fax:561-844-4166
Is Sole Proprietor?:No
Enumeration Date:2016-12-11
Last Update Date:2017-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA66976225700000X, 172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No172M00000XOther Service ProvidersMechanotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13950338OtherCAQH NUMBER
FL45-4029726OtherLUXURY QUALITY TYME INC
FL623618300OtherWORKER'S COMP NUMBER