Basic Information
| Provider Information | |||||||||
| NPI: | 1265618987 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERREIRA | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | LANE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT, OCS, MTC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 190 SOUTHPARK BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320864120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048241478 | ||||||||
| FaxNumber: | 9048248071 | ||||||||
| Practice Location | |||||||||
| Address1: | 190 SOUTHPARK BLVD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ST AUGUSTINE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 320864120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9048241478 | ||||||||
| FaxNumber: | 9048248071 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2008 | ||||||||
| LastUpdateDate: | 05/15/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 23808 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.