MEDICARE: DR. LISA PT LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1073243762
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. LISA PT LLC

Provider Business Mailing Address
First Line	:	1080 99TH ST APT 221
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-1754
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1080 99TH ST APT 221
Second Line	:
City	:	BAY HARBOR ISLANDS
State	:	FL
Zip	:	33154-1754
Country	:	US
Telephone Number	:	305-467-9421
Fax Number	:

Authorized Official
Title or Position	:	AMBR
Name	:	LISA FERNANDEZ
Credential	:	DPT
Telephone Number	:	305-467-9421

Provider Enumeration Date	:	06/15/2022
Last Update Date	:	08/23/2022

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