MEDICARE: MISS LISA A SAEZ 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	QA03408	NJ

General Provider Information

NPI Number	:	1245292838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LISA A SAEZ P.T.

Provider Business Mailing Address
First Line	:	652 BAYVIEW DR
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08753-2006
Country	:	US
Telephone Number	:	732-255-1264
Fax Number	:

Provider Business Practice Location Address
First Line	:	1985 HIGHWAY 34
Second Line	:	UNIT A5
City	:	WALL
State	:	NJ
Zip	:	07719-9100
Country	:	US
Telephone Number	:	732-282-9228
Fax Number	:	732-282-9227

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	07/08/2007

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