Provider Demographics
NPI:1821248170
Name:DOEBLE, LANCE D (MSPT)
Entity type:Individual
Prefix:MR
First Name:LANCE
Middle Name:D
Last Name:DOEBLE
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 KINGS HWY UNIT 2F
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-5760
Mailing Address - Country:US
Mailing Address - Phone:941-888-4561
Mailing Address - Fax:941-444-0599
Practice Address - Street 1:2200 KINGS HWY UNIT 2F
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-5760
Practice Address - Country:US
Practice Address - Phone:941-888-4561
Practice Address - Fax:941-347-4695
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-23
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist