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General NPI Number Information
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NPI Number | 1699891655
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Entity Type | Individual
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Provider Name | DWIGHT T. SWEAT L.M.T., P.T.A.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 1394 NW LABONTE LN
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City | LAKE CITY
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State | FL
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Zip | 32055-2578
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Country | US
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Telephone | 386-752-5272
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Fax |
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Provider Business Mailing Address
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Address Line | 1394 NW LABONTE LN
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City | LAKE CITY
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State | FL
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Zip | 32055-2578
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Country | US
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Telephone | 386-752-5272
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA20982
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA 38578
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License Number State | FL
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