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General NPI Number Information
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NPI Number | 1073243762
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Entity Type | Organization
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Legal Business Name | DR. LISA PT LLC
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 08/23/2022
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Provider Practice Location Address
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Address Line | 1080 99TH ST APT 221
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City | BAY HARBOR ISLANDS
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State | FL
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Zip | 33154-1754
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Country | US
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Telephone | 305-467-9421
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Fax |
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Provider Business Mailing Address
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Address Line | 1080 99TH ST APT 221
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City | BAY HARBOR ISLANDS
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State | FL
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Zip | 33154-1754
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AMBR
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Name | LISA FERNANDEZ
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Credential | DPT
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Telephone | 305-467-9421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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