=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023287471
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA KAREN PEZZULLO CRTT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/29/2008
-----------------------------------------------------
Last Update Date | 07/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10547 SW SUNRAY ST
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34987-7721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-649-4587
-----------------------------------------------------
Fax | 727-674-1816
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10547 SW SUNRAY ST
-----------------------------------------------------
City | PORT ST LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34987-7721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-649-4587
-----------------------------------------------------
Fax | 727-674-1816
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 227800000X
-----------------------------------------------------
Taxonomy Name | Certified Respiratory Therapist
-----------------------------------------------------
License Number | TT8731
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2278H0200X
-----------------------------------------------------
Taxonomy Name | Home Health Certified Respiratory Therapist
-----------------------------------------------------
License Number | TT8731
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------