MEDICARE: MRS. LISA LYNN GIUMMO P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT0011615	FL

General Provider Information

NPI Number	:	1093942237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA LYNN GIUMMO P.T.

Provider Business Mailing Address
First Line	:	743 S BENEVA RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34232-2411
Country	:	US
Telephone Number	:	941-953-9613
Fax Number	:

Provider Business Practice Location Address
First Line	:	743 S BENEVA RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34232-2411
Country	:	US
Telephone Number	:	941-953-9613
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2009
Last Update Date	:	06/15/2009

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