MEDICARE: MS. LISA MARIE BETTIO M.S.R.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	007195	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	650025450	OTHER	GA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	853202	OTHER	GA	BCBS

General Provider Information

NPI Number	:	1699774356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA MARIE BETTIO M.S.R.P.T.

Provider Business Mailing Address
First Line	:	8872 FORD AVE STE 206
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-6092
Country	:	US
Telephone Number	:	912-312-2766
Fax Number	:

Provider Business Practice Location Address
First Line	:	8872 FORD AVE STE 206
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-6092
Country	:	US
Telephone Number	:	912-312-2766
Fax Number	:

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	09/20/2022

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