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General NPI Number Information
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NPI Number | 1548539752
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Entity Type | Individual
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Provider Name | LISA J SMITH LMT
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Gender | Female
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Dates
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Enumeration Date | 12/16/2011
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Last Update Date | 12/16/2011
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Provider Practice Location Address
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Address Line | 1915 NE 45TH ST SUITE 104B
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City | FT LAUDERDALE
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State | FL
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Zip | 33308-5199
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Country | US
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Telephone | 954-415-6285
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Fax | 954-782-6564
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Provider Business Mailing Address
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Address Line | 1900 NE 28TH AVE
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City | POMPANO BEACH
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State | FL
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Zip | 33062-3119
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Country | US
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Telephone | 954-415-6285
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Fax | 954-782-6564
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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 | MA56206
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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 | MM27808
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License Number State | FL
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