Healthcare Provider Details

I. General information

NPI: 1518026665
Provider Name (Legal Business Name): DAVID CLYDE LOWER PT,DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 SW MAIN BLVD
LAKE CITY FL
32025-5746
US

IV. Provider business mailing address

PO BOX 632670
CINCINNATI OH
45263-2670
US

V. Phone/Fax

Practice location:
  • Phone: 386-755-3164
  • Fax: 386-755-3165
Mailing address:
  • Phone: 386-755-3164
  • Fax: 386-755-3165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT12687
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: