Individual
LISA M BACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
394 N SUNCOAST BLVD, SUITE 40, CRYSTAL RIVER, FL 34429-5466
(352) 795-6225
(352) 795-6065
Mailing address
394 N SUNCOAST BLVD, SUITE 40, CRYSTAL RIVER, FL 34429-5466
(352) 795-6225
(352) 795-6065
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA18639
FL
Other
Enumeration date
05/29/2008
Last updated
05/29/2008
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