MEDICARE: MISS CHRISTINE ACUMABIG LALISAN RPT

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	225100000X	Physical Therapist	11326	NC

General Provider Information

NPI Number	:	1376726190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS CHRISTINE ACUMABIG LALISAN RPT

Provider Business Mailing Address
First Line	:	1751 SORRELL BROOK WAY
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-5097
Country	:	US
Telephone Number	:	919-954-7060
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 W COMMERCIAL BLVD
Second Line	:	STE #116
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-3440
Country	:	US
Telephone Number	:	954-332-4445
Fax Number	:	866-422-6431

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2007
Last Update Date	:	12/15/2007

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