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General NPI Number Information
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NPI Number | 1770801631
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Entity Type | Individual
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Provider Name | JUDITH ELAINE LIEBESPACH LMT
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Gender | Female
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Dates
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Enumeration Date | 05/17/2010
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Last Update Date | 05/17/2010
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Provider Practice Location Address
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Address Line | 502 S KINGS AVE
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City | BRANDON
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State | FL
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Zip | 33511-5922
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Country | US
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Telephone | 813-857-5871
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Fax |
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Provider Business Mailing Address
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Address Line | 1832 S RIDGE DR
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City | VALRICO
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State | FL
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Zip | 33594-5547
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Country | US
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Telephone | 813-653-0459
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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 | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | MA10753
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License Number State | FL
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