Provider Demographics
NPI:1295628774
Name:LALLAMANT, QUYEN THI
Entity type:Individual
Prefix:
First Name:QUYEN
Middle Name:THI
Last Name:LALLAMANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 E BLOOMINGDALE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8184
Mailing Address - Country:US
Mailing Address - Phone:813-764-3823
Mailing Address - Fax:
Practice Address - Street 1:132 E BLOOMINGDALE AVE STE B
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8184
Practice Address - Country:US
Practice Address - Phone:813-764-3823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty