Provider Demographics
NPI:1306686191
Name:LOVERIDGE, CAMERON DAVID (DPT)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:DAVID
Last Name:LOVERIDGE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 LUDLAM RD APT 108
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1869
Mailing Address - Country:US
Mailing Address - Phone:801-854-0254
Mailing Address - Fax:
Practice Address - Street 1:100210 OVERSEAS HWY STE 2
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2527
Practice Address - Country:US
Practice Address - Phone:305-453-1088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT41697225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist