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General NPI Number Information
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NPI Number | 1508047291
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Entity Type | Organization
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Legal Business Name | LAKELAND PROFESSIONAL HEARING CENTER, INC.
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 11/21/2007
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Provider Practice Location Address
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Address Line | 5353 N SOCRUM LOOP RD
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City | LAKELAND
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State | FL
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Zip | 33809-4256
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Country | US
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Telephone | 863-859-0754
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Fax | 863-859-4630
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Provider Business Mailing Address
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Address Line | 5353 N SOCRUM LOOP RD
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City | LAKELAND
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State | FL
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Zip | 33809-4256
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Country | US
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Telephone | 863-859-0754
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Fax | 863-859-4630
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Authorized Official
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Title or Position | AUDIOLOGIST/CEO
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Name | MRS. TONYA L SHOWALTER
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Credential | M.S.
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Telephone | 863-859-0754
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AY1201
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License Number State | FL
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