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General NPI Number Information
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NPI Number | 1093288136
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Entity Type | Individual
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Provider Name | LISA G ROZENTAL
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Gender | Female
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Dates
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Enumeration Date | 01/10/2019
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Last Update Date | 01/24/2019
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Provider Practice Location Address
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Address Line | 120 LOS ARBOR DR
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City | DELAND
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State | FL
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Zip | 32724-1263
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Country | US
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Telephone | 386-717-6150
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Fax | 386-873-7387
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Provider Business Mailing Address
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Address Line | 120 LOS ARBOR DR
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City | DELAND
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State | FL
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Zip | 32724-1263
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Country | US
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Telephone | 386-717-6150
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Fax | 386-873-7387
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 015394200
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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