Provider Demographics
NPI:1306998943
Name:DEWITT, LORRAINE (PT)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:DEWITT
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 1:12030 NW 30TH PL
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-1524
Mailing Address - Country:US
Mailing Address - Phone:954-742-3730
Mailing Address - Fax:954-742-3730
Practice Address - Street 1:12030 NW 30TH PL
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-1524
Practice Address - Country:US
Practice Address - Phone:954-742-3730
Practice Address - Fax:954-742-3730
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 5188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118727100Medicaid