Provider Demographics
NPI:1013519032
Name:WASHINGTON, LAPOLOEAN (PT, NUTRITIONIST)
Entity Type:Individual
Prefix:
First Name:LAPOLOEAN
Middle Name:
Last Name:WASHINGTON
Suffix:
Gender:M
Credentials:PT, NUTRITIONIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10024 STRAFFORD OAK CT APT 817
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-5153
Mailing Address - Country:US
Mailing Address - Phone:813-260-8120
Mailing Address - Fax:
Practice Address - Street 1:10024 STRAFFORD OAK CT APT 817
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-5153
Practice Address - Country:US
Practice Address - Phone:813-260-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Multi-Specialty