MEDICARE: LISA BERCEGEAY B.A., LMT, CST-P

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	171W00000X	Contractor	LA5459	LA

General Provider Information

NPI Number	:	1134653025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BERCEGEAY B.A., LMT, CST-P

Provider Business Mailing Address
First Line	:	45016 GOLD PLACE RD
Second Line	:
City	:	SAINT AMANT
State	:	LA
Zip	:	70774-3619
Country	:	US
Telephone Number	:	225-571-2943
Fax Number	:

Provider Business Practice Location Address
First Line	:	45016 GOLD PLACE RD
Second Line	:
City	:	SAINT AMANT
State	:	LA
Zip	:	70774-3619
Country	:	US
Telephone Number	:	225-571-2943
Fax Number	:

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

Provider Enumeration Date	:	04/17/2017
Last Update Date	:	04/17/2017

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