Provider Demographics
NPI:1184842072
Name:JAVIER, LISSETTE LYNN (MPT, ATC)
Entity Type:Individual
Prefix:MISS
First Name:LISSETTE
Middle Name:LYNN
Last Name:JAVIER
Suffix:
Gender:F
Credentials:MPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 NAUSET LN
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-4310
Mailing Address - Country:US
Mailing Address - Phone:630-750-5038
Mailing Address - Fax:
Practice Address - Street 1:947 VINERIDGE RUN
Practice Address - Street 2:#9-103
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-1762
Practice Address - Country:US
Practice Address - Phone:630-750-5038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 22966225100000X
IL225100000X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer