Lisa M Back
Individual provider Active NPI Physical Therapy Assistant · Crystal River, FL
NPI 1174781983 · NPPES record last updated May 29, 2008
Key facts
- NPI
- 1174781983
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- License
- PTA18639 (FL)
- Practice address
- 394 N Suncoast Blvd
Suite 40
Crystal River, FL 34429-5466 - Phone
- (352) 795-6225
- Fax
- (352) 795-6065
- NPI assigned
- May 29, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA18639 | FL | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| TLC Rehab, LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA18639 | FL | Yes |
Addresses
Primary practice location
394 N Suncoast Blvd
Suite 40
Crystal River, FL 34429-5466
Mailing address
394 N Suncoast Blvd
Suite 40
Crystal River, FL 34429-5466
Phone (352) 795-6225
Other providers in Crystal River, FL
- Lauren Arnold
- Arthritis & Osteoporosis Clinics of Florida, Inc.
- Anthony Asaro
- Jami Austin
- B Jeffrey Wallis MD PA
- Stacy Lynn Bahner
- Glendora Y Baker
- Richard Baker
- Ryte Baksiene
- Barbara J Barfield
All providers in Crystal River, FL · Physical Therapy Assistant in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.