MEDICARE: PETER JEROME LORD PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT353	FL

General Provider Information

NPI Number	:	1104095496
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER JEROME LORD PHD

Provider Business Mailing Address
First Line	:	720 SAINT JOHNS BLUFF RD N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-6704
Country	:	US
Telephone Number	:	904-646-1144
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 SAINT JOHNS BLUFF RD N
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-6704
Country	:	US
Telephone Number	:	904-646-1144
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2008
Last Update Date	:	02/21/2008

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Directions to “ PETER JEROME LORD PHD” Practice Location

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