Provider Demographics
NPI:1174644108
Name:DOLEZEL, LISA M (PT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:DOLEZEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4490 BEECHWOOD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34112-5267
Mailing Address - Country:US
Mailing Address - Phone:315-727-5158
Mailing Address - Fax:
Practice Address - Street 1:4490 BEECHWOOD LAKE DR
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34112-5267
Practice Address - Country:US
Practice Address - Phone:315-727-5158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22589225100000X
NY019321225100000X
PAPT018784225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist