Healthcare Provider Details

I. General information

NPI: 1568575546
Provider Name (Legal Business Name): KATHLEEN LORMIL L.M.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 HEARTHGLEN BLVD
WINTER GARDEN FL
34787-4524
US

IV. Provider business mailing address

548 HEARTHGLEN BLVD
WINTER GARDEN FL
34787-4524
US

V. Phone/Fax

Practice location:
  • Phone: 407-949-1106
  • Fax: 407-614-4573
Mailing address:
  • Phone: 407-949-1106
  • Fax: 407-614-4573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA34943
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT34943
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT34943
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT34943
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: