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General NPI Number Information
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NPI Number | 1174818918
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Entity Type | Individual
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Provider Name | LISA CRISTOBAL GACULA PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 06/09/2011
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Last Update Date | 07/03/2011
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Provider Practice Location Address
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Address Line | 1475 N GRANITE REEF RD
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City | SCOTTSDALE
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State | AZ
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Zip | 85257-3919
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Country | US
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Telephone | 480-421-1776
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Fax |
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Provider Business Mailing Address
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Address Line | 8334 E VIA DE LA ESCUELA
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City | SCOTTSDALE
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State | AZ
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Zip | 85258-3203
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Country | US
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Telephone | 480-241-4037
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 9271
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License Number State | AZ
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