MEDICARE: LISA FAIL PT

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	1978	AZ

General Provider Information

NPI Number	:	1447559638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA FAIL PT

Provider Business Mailing Address
First Line	:	5130 E CAMINO FRANCISCO SOZA
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-5530
Country	:	US
Telephone Number	:	520-400-2153
Fax Number	:	520-615-1951

Provider Business Practice Location Address
First Line	:	5130 E CAMINO FRANCISCO SOZA
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85718-5530
Country	:	US
Telephone Number	:	520-400-2153
Fax Number	:	520-615-1951

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

Provider Enumeration Date	:	03/28/2011
Last Update Date	:	03/28/2011

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