Provider Demographics
NPI:1477798866
Name:WASKO, LYAM CRISTINA (LMT)
Entity Type:Individual
Prefix:
First Name:LYAM
Middle Name:CRISTINA
Last Name:WASKO
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 1:15212 99TH ST N
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33412-2536
Mailing Address - Country:US
Mailing Address - Phone:561-779-5985
Mailing Address - Fax:561-798-5303
Practice Address - Street 1:15212 99TH ST N
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33412-2536
Practice Address - Country:US
Practice Address - Phone:561-779-5985
Practice Address - Fax:561-798-5303
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-13
Last Update Date:2008-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 43950172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist