Provider Demographics
NPI:1669703765
Name:SARDINAS, LOURDERS M (MT)
Entity type:Individual
Prefix:
First Name:LOURDERS
Middle Name:M
Last Name:SARDINAS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 DANIELS PKWY STE 8
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-0872
Mailing Address - Country:US
Mailing Address - Phone:239-313-6300
Mailing Address - Fax:239-689-5524
Practice Address - Street 1:8911 DANIELS PKWY STE 8
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-0872
Practice Address - Country:US
Practice Address - Phone:239-313-6300
Practice Address - Fax:239-689-5524
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA49170225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist