Provider Demographics
NPI:1699891655
Name:SWEAT, DWIGHT T (LMT, PTA)
Entity type:Individual
Prefix:MR
First Name:DWIGHT
Middle Name:T
Last Name:SWEAT
Suffix:
Gender:M
Credentials:LMT, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1394 NW LABONTE LN
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32055-2578
Mailing Address - Country:US
Mailing Address - Phone:386-752-5272
Mailing Address - Fax:
Practice Address - Street 1:1394 NW LABONTE LN
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32055-2578
Practice Address - Country:US
Practice Address - Phone:386-752-5272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA20982225200000X
FLMA 38578225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690499896Medicaid