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General NPI Number Information
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NPI Number | 1700013547
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Entity Type | Individual
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Provider Name | ANNALISA NA P.T.
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Gender | Female
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Dates
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Enumeration Date | 06/19/2009
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 727 SE MAIN ST SUITE 200
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City | SIMPSONVILLE
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State | SC
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Zip | 29681-3247
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Country | US
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Telephone | 864-454-6670
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Fax | 864-454-6675
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Provider Business Mailing Address
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Address Line | 125 THE PKWY SUITE 501
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City | GREENVILLE
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State | SC
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Zip | 29615-6610
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Country | US
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Telephone | 864-528-5707
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Fax | 864-528-5701
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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 | 5965
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License Number State | SC
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