Provider Demographics
NPI:1134475494
Name:CHEKANOWSKY, LISA M (ATC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:CHEKANOWSKY
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1325 SAN MARCO BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-8568
Mailing Address - Country:US
Mailing Address - Phone:904-858-7045
Mailing Address - Fax:904-858-7047
Practice Address - Street 1:1845 TOWN CENTER BLVD
Practice Address - Street 2:SUITE 410
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-3356
Practice Address - Country:US
Practice Address - Phone:904-621-0396
Practice Address - Fax:904-621-0397
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAL29422255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer