Provider Demographics
NPI:1417220740
Name:MAYER, LISSIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:LISSIE
Middle Name:
Last Name:MAYER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2740 MAITLAND CROSSING WAY APT 2203
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-7130
Mailing Address - Country:US
Mailing Address - Phone:404-797-4130
Mailing Address - Fax:
Practice Address - Street 1:2740 MAITLAND CROSSING WAY APT 2203
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-7130
Practice Address - Country:US
Practice Address - Phone:404-797-4130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26397208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation