Healthcare Provider Details

I. General information

NPI: 1871899286
Provider Name (Legal Business Name): LALU THOMAS RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2011
Last Update Date: 02/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5715 HAYES ST
HOLLYWOOD FL
33021-5182
US

IV. Provider business mailing address

5715 HAYES ST
HOLLYWOOD FL
33021-5182
US

V. Phone/Fax

Practice location:
  • Phone: 954-812-7366
  • Fax:
Mailing address:
  • Phone: 954-812-7366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT10591
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: