Provider Demographics
NPI:1144537358
Name:LUGO, LUIS ALBERTO JR (LMT)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:ALBERTO
Last Name:LUGO
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 GRANADA ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2207
Mailing Address - Country:US
Mailing Address - Phone:863-808-7914
Mailing Address - Fax:
Practice Address - Street 1:5130 S FLORIDA AVE STE 410
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2539
Practice Address - Country:US
Practice Address - Phone:863-937-8814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA56106225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist