MEDICARE: LISA MICHELE MICHELANGELO MPT

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	111NR0400X	Rehabilitation Chiropractor	PT17695	FL

General Provider Information

NPI Number	:	1750510475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MICHELE MICHELANGELO MPT

Provider Business Mailing Address
First Line	:	17419 BRIDGE HILL COURT
Second Line	:	SUITE C
City	:	TAMPA
State	:	FL
Zip	:	33647
Country	:	US
Telephone Number	:	813-907-7879
Fax Number	:	813-994-3080

Provider Business Practice Location Address
First Line	:	17419 BRIDGE HILL CT
Second Line	:	SUITE C
City	:	TAMPA
State	:	FL
Zip	:	33647-3467
Country	:	US
Telephone Number	:	813-907-7879
Fax Number	:	813-994-3080

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

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	07/02/2009

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