Provider Demographics
NPI:1811156631
Name:MOORE, LOLITA C (LMT)
Entity type:Individual
Prefix:MRS
First Name:LOLITA
Middle Name:C
Last Name:MOORE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:600 HERITAGE DR
Mailing Address - Street 2:110
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3000
Mailing Address - Country:US
Mailing Address - Phone:561-253-8737
Mailing Address - Fax:561-253-8966
Practice Address - Street 1:600 HERITAGE DR
Practice Address - Street 2:110
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3000
Practice Address - Country:US
Practice Address - Phone:561-253-8737
Practice Address - Fax:561-253-8966
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLMA30667225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist