Provider Demographics
NPI:1184065369
Name:PERKINS, LONNIE LEE (LMT)
Entity type:Individual
Prefix:MR
First Name:LONNIE
Middle Name:LEE
Last Name:PERKINS
Suffix:
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 1:4049 GLENWAY DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-8063
Mailing Address - Country:US
Mailing Address - Phone:850-723-1930
Mailing Address - Fax:
Practice Address - Street 1:6706 N 9TH AVE
Practice Address - Street 2:B1
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-9303
Practice Address - Country:US
Practice Address - Phone:850-723-1930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL73279225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist