Provider Demographics
NPI:1184798126
Name:LOZANO, HUMBERTO (PT)
Entity type:Individual
Prefix:
First Name:HUMBERTO
Middle Name:
Last Name:LOZANO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 N COMMERCE PKWY
Mailing Address - Street 2:2
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3250
Mailing Address - Country:US
Mailing Address - Phone:954-888-6650
Mailing Address - Fax:954-208-0260
Practice Address - Street 1:2237 N COMMERCE PKWY
Practice Address - Street 2:2
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3250
Practice Address - Country:US
Practice Address - Phone:954-888-6650
Practice Address - Fax:954-208-0260
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT8717225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBS765OtherGROUP PTAN
FL1184798126OtherINDIVIDUAL NPI
FL1245413194OtherGROUP NPI
FL1184798126OtherINDIVIDUAL NPI
FL1184798126OtherINDIVIDUAL NPI