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General NPI Number Information
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NPI Number | 1598060824
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Entity Type | Individual
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Provider Name | VALERIE LISIECKI MS, ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 01/24/2015
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Provider Practice Location Address
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Address Line | 9446 PHILIPS HWY STE 3
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City | JACKSONVILLE
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State | FL
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Zip | 32256-1358
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Country | US
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Telephone | 904-739-4170
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Fax |
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Provider Business Mailing Address
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Address Line | 536 N BRIDGESTONE AVE
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City | SAINT JOHNS
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State | FL
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Zip | 32259-7972
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL2410
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License Number State | FL
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