Provider Demographics
NPI:1992934293
Name:LYDA, MAUREEN MCCARTHY (LMT)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:MCCARTHY
Last Name:LYDA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 OLD DIXIE HWY
Mailing Address - Street 2:A-3
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4311
Mailing Address - Country:US
Mailing Address - Phone:772-538-3081
Mailing Address - Fax:
Practice Address - Street 1:951 OLD DIXIE HWY
Practice Address - Street 2:A-3
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-4311
Practice Address - Country:US
Practice Address - Phone:772-538-3081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA4835225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist