Provider Demographics
NPI:1215065602
Name:LAMPERT, ROSE M (PT)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:LAMPERT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8254 118TH AVENUE
Mailing Address - Street 2:STE 100
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-5027
Mailing Address - Country:US
Mailing Address - Phone:727-541-5304
Mailing Address - Fax:727-546-8527
Practice Address - Street 1:8254 118TH AVENUE
Practice Address - Street 2:STE 100
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33773-5027
Practice Address - Country:US
Practice Address - Phone:727-541-5304
Practice Address - Fax:727-546-8527
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT10184225100000X
FL812051000222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL885664800Medicaid
FL812051000Medicaid