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NPI Code Detail

MEDICARE: LISA M BACK

MEDICARE: LISA M BACK
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
1225200000XPhysical Therapy AssistantPTA18639FL

General Provider Information

NPI Number : 1174781983
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA M BACK
Provider Business Mailing Address
First Line : 394 N SUNCOAST BLVD
Second Line : SUITE 40
City : CRYSTAL RIVER
State : FL
Zip : 34429-5466
Country : US
Telephone Number : 352-795-6225
Fax Number : 352-795-6065
Provider Business Practice Location Address
First Line : 394 N SUNCOAST BLVD
Second Line : SUITE 40
City : CRYSTAL RIVER
State : FL
Zip : 34429-5466
Country : US
Telephone Number : 352-795-6225
Fax Number : 352-795-6065
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/29/2008
Last Update Date : 05/29/2008

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Directions to “ LISA M BACK ” Practice Location

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