Individual
LISA INNISS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1699 SE LYNGATE DR, PORT ST LUCIE, FL 34952-5016
(772) 335-9990
Mailing address
2586 SW MONTERREY LN, PORT ST LUCIE, FL 34953-2956
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA19331
FL
Other
Enumeration date
06/30/2010
Last updated
06/30/2010
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