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General NPI Number Information
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NPI Number | 1881636504
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Entity Type | Individual
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Provider Name | LISA A. DE PALMA P.T.
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Gender | Female
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Dates
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Enumeration Date | 06/11/2006
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Last Update Date | 09/16/2024
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Provider Practice Location Address
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Address Line | 4600 MIDDLETON PARK CIR E
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City | JACKSONVILLE
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State | FL
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Zip | 32224-5691
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Country | US
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Telephone | 904-223-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 268 WATERS EDGE DR S
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City | PONTE VEDRA BEACH
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State | FL
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Zip | 32082-2579
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Country | US
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Telephone | 904-460-7415
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Fax | 732-229-4342
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 23615
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License Number State | FL
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