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Individual

LYDIA RUTH MACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT, DPT

Contact information

Practice address
830 29TH ST, ORLANDO, FL 32805-6219
(407) 843-3230
Mailing address
1000 PLANTATION LAKES CIR APT 6106, SANFORD, FL 32771-7304

Taxonomy

Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
050731
NY
208100000X
Physical Medicine & Rehabilitation Physician
Primary
PT41868
FL

Other

Enumeration date
09/04/2024
Last updated
09/04/2024
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