Provider Demographics
NPI:1275735359
Name:CONSUNJI, LIANNE CECILE TABARES (RPT)
Entity Type:Individual
Prefix:MISS
First Name:LIANNE CECILE
Middle Name:TABARES
Last Name:CONSUNJI
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2077 DIXIE BELLE DRIVE
Mailing Address - Street 2:UNIT O
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-5390
Mailing Address - Country:US
Mailing Address - Phone:561-809-6579
Mailing Address - Fax:
Practice Address - Street 1:989 ORIENTA AVENUE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701
Practice Address - Country:US
Practice Address - Phone:407-831-3446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23165225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist