Active NPI
Lisa Marie Childress, PT, DPT
- Physical Therapist
- Tampa, FL
National Provider Identifier
1679700355
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 24749
- Practice address
- 14460 Bruce B Downs Blvd
Tampa, FL 33613-2612 - Phone
- (813) 977-5255
- NPI assigned
- Jun 19, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT 24749 | FL | Primary |
Addresses
Primary practice location
14460 Bruce B Downs Blvd
Tampa, FL 33613-2612
Mailing address
4039 Cactus Needle Lane
Wesley Chapel, FL 33544
Phone (813) 395-2715
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 24749 | FL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cora Health Services, Inc | Past | Accepting new patients | |
| Public Hospital District No 4 King County Washington | Past | Accepting new patients | |
| Cora Health Services, Inc | Past | Accepting new patients |
Networks
- Freedom Health HMO Network
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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-
- Critical Access Hospital
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- NPI 1902846546
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245369600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245369600000",
"number": "1679700355",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4039 CACTUS NEEDLE LANE",
"city": "WESLEY CHAPEL",
"state": "FL",
"postal_code": "33544",
"telephone_number": "813-395-2715"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14460 BRUCE B DOWNS BLVD",
"city": "TAMPA",
"state": "FL",
"postal_code": "336132612",
"telephone_number": "813-977-5255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHILDRESS",
"first_name": "LISA",
"middle_name": "MARIE",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-06-19",
"last_updated": "2009-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT 24749",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.