Provider Demographics
NPI:1790837631
Name:LALONDE, MARC (PTA, CKTP)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:
Last Name:LALONDE
Suffix:
Gender:M
Credentials:PTA, CKTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 NE 26TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1427
Mailing Address - Country:US
Mailing Address - Phone:954-821-0271
Mailing Address - Fax:
Practice Address - Street 1:1881 NE 26TH ST STE 101
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1427
Practice Address - Country:US
Practice Address - Phone:954-821-0271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2013-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19787225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46-4342757OtherEIN