MEDICARE: MS. LISA DECAMPS LMT

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	225700000X	Massage Therapist	MA51768	FL

General Provider Information

NPI Number	:	1437327954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA DECAMPS LMT

Provider Business Mailing Address
First Line	:	2354 HARBOR TOWN DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-5142
Country	:	US
Telephone Number	:	407-288-5607
Fax Number	:

Provider Business Practice Location Address
First Line	:	2354 HARBOR TOWN DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34744-5142
Country	:	US
Telephone Number	:	407-288-5607
Fax Number	:

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

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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