Provider Demographics
NPI:1750637864
Name:DIPOLLINA, MARTHA LUCIA
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:LUCIA
Last Name:DIPOLLINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARHA
Other - Middle Name:LUCIA
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5102 BURNSIDE CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-5077
Mailing Address - Country:US
Mailing Address - Phone:813-293-0959
Mailing Address - Fax:
Practice Address - Street 1:708 PEARL CIR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4246
Practice Address - Country:US
Practice Address - Phone:813-409-0435
Practice Address - Fax:813-655-4814
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist