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General NPI Number Information
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NPI Number | 1417177999
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Entity Type | Individual
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Provider Name | LISA JACQUES CALIA LMT
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Gender | Female
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 13690 US HWY 441 STE 300
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City | LADY LAKE
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State | FL
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Zip | 32159
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Country | US
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Telephone | 352-750-0678
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Fax | 352-750-0523
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Provider Business Mailing Address
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Address Line | PO BOX 1086
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City | SUMMERFIELD
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State | FL
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Zip | 34492-1086
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Country | US
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Telephone | 352-750-0678
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Fax | 352-750-0523
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MM9387
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA14283
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License Number State | FL
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