Provider Demographics
NPI:1073079802
Name:MURPHY, LISA B (MBA FMT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:MURPHY
Suffix:
Gender:F
Credentials:MBA FMT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:B
Other - Last Name:CHOMKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9301 W HIGHWAY 316
Mailing Address - Street 2:
Mailing Address - City:REDDICK
Mailing Address - State:FL
Mailing Address - Zip Code:32686-3054
Mailing Address - Country:US
Mailing Address - Phone:352-949-4012
Mailing Address - Fax:
Practice Address - Street 1:9301 W HIGHWAY 316
Practice Address - Street 2:
Practice Address - City:REDDICK
Practice Address - State:FL
Practice Address - Zip Code:32686-3054
Practice Address - Country:US
Practice Address - Phone:352-949-4012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty