Individual
LISA MALT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MED
Contact information
Practice address
1614 COLONIAL BLVD, FORT MYERS, FL 33907-1135
(239) 936-6724
Mailing address
1225 SW 34TH TER, CAPE CORAL, FL 33914-5147
(239) 850-1127
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/07/2018
Last updated
05/07/2018
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