Provider Demographics
NPI:1417177999
Name:CALIA, LISA JACQUES (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:JACQUES
Last Name:CALIA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34492-1086
Mailing Address - Country:US
Mailing Address - Phone:352-750-0678
Mailing Address - Fax:352-750-0523
Practice Address - Street 1:13690 US HWY 441 STE 300
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159
Practice Address - Country:US
Practice Address - Phone:352-750-0678
Practice Address - Fax:352-750-0523
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM9387225700000X
FLMA14283225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC7261OtherBLUE CROSS BLUE SHIELD