Healthcare Provider Details

I. General information

NPI: 1780745562
Provider Name (Legal Business Name): LISA GEORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 05/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 SW HIGHWAY 200 SUITE 2001
OCALA FL
34481-9612
US

IV. Provider business mailing address

9401 SW HIGHWAY 200 SUITE 2001
OCALA FL
34481-9612
US

V. Phone/Fax

Practice location:
  • Phone: 352-854-4017
  • Fax: 352-854-4389
Mailing address:
  • Phone: 352-854-4017
  • Fax: 352-854-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0003979
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: