MEDICARE: LISA GONZALEZ LMT

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	225700000X	Massage Therapist	MA47575	FL

General Provider Information

NPI Number	:	1770726655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA GONZALEZ LMT

Provider Business Mailing Address
First Line	:	5801 ARGERIAN DR STE 101
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33545-4145
Country	:	US
Telephone Number	:	813-907-2774
Fax Number	:	813-907-2723

Provider Business Practice Location Address
First Line	:	5801 ARGERIAN DR STE 101
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33545-4145
Country	:	US
Telephone Number	:	813-907-2774
Fax Number	:	813-907-2723

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

Provider Enumeration Date	:	04/08/2009
Last Update Date	:	04/08/2009

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