Provider Demographics
NPI:1174818918
Name:GACULA, LISA CRISTOBAL (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:CRISTOBAL
Last Name:GACULA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8334 E VIA DE LA ESCUELA
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-3203
Mailing Address - Country:US
Mailing Address - Phone:480-241-4037
Mailing Address - Fax:
Practice Address - Street 1:1475 N GRANITE REEF RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-3919
Practice Address - Country:US
Practice Address - Phone:480-421-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2011-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist