Provider Demographics
NPI:1407661093
Name:LOWE, TIMOTHY MARK (LMT)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:MARK
Last Name:LOWE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1418 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-1318
Mailing Address - Country:US
Mailing Address - Phone:386-295-3882
Mailing Address - Fax:
Practice Address - Street 1:1418 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-1318
Practice Address - Country:US
Practice Address - Phone:386-295-3882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-11
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA102438225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist