MEDICARE: LIZELLE LAPUZ PTA

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	225200000X	Physical Therapy Assistant	PTA26737	FL

General Provider Information

NPI Number	:	1578015996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIZELLE LAPUZ PTA

Provider Business Mailing Address
First Line	:	236 PONTE VEDRA PARK DR
Second Line	:	STE 300
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-6619
Country	:	US
Telephone Number	:	904-280-3440
Fax Number	:	904-280-3444

Provider Business Practice Location Address
First Line	:	236 PONTE VEDRA PARK DR
Second Line	:	SUITE 300
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-6619
Country	:	US
Telephone Number	:	904-280-3440
Fax Number	:

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

Provider Enumeration Date	:	11/02/2016
Last Update Date	:	11/02/2016

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Directions to “ LIZELLE LAPUZ PTA” Practice Location

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