MEDICARE: LISA ANNETTE FOX

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	8605	OH

General Provider Information

NPI Number	:	1558577759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA ANNETTE FOX

Provider Business Mailing Address
First Line	:	2021 WASHINGTON BLVD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44709-2766
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6200 WHIPPLE AVE NW
Second Line	:
City	:	NORTH CANTON
State	:	OH
Zip	:	44720-7624
Country	:	US
Telephone Number	:	330-966-8920
Fax Number	:

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	07/08/2007

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Directions to “ LISA ANNETTE FOX ” Practice Location

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