1679546683 NPI number — MRS. KARA LEE LUMBRA P.T.

Table of content: MRS. KARA LEE LUMBRA P.T. (NPI 1679546683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679546683 NPI number — MRS. KARA LEE LUMBRA P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUMBRA
Provider First Name:
KARA
Provider Middle Name:
LEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAILLARGEON
Provider Other First Name:
KARA
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679546683
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 CHAMPLAIN COMMONS
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
ST ALBANS
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-524-1155
Provider Business Mailing Address Fax Number:
802-524-2664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 CHAMPLAIN CMNS
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
ST ALBANS
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05478-1563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-524-1155
Provider Business Practice Location Address Fax Number:
802-524-2664
Provider Enumeration Date:
02/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2251X0800X , with the licence number:  0400003432 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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