Healthcare Provider Details

I. General information

NPI: 1669398921
Provider Name (Legal Business Name): MAX LOMBARDO DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 LUPI CT STE 150
PALM COAST FL
32137-4761
US

IV. Provider business mailing address

531 BAY LAUREL DR APT 63012
ST AUGUSTINE FL
32084-0209
US

V. Phone/Fax

Practice location:
  • Phone: 386-447-0011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: