=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588976070
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LISA MARIE CHLAPOWSKI LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/13/2010
-----------------------------------------------------
Last Update Date | 02/10/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3680 61ST STREET NORTH
-----------------------------------------------------
City | ST. PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-709-0714
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3680 61ST STREET NORTH
-----------------------------------------------------
City | ST. PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-709-0714
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MA53428
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------