Provider Demographics
NPI:1538293295
Name:HOTALING, LISA (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HOTALING
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:AARONSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:FYZICAL LAKEWOOD RANCH
Mailing Address - Street 2:5860 RANCH LAKE BLVD #102
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202
Mailing Address - Country:US
Mailing Address - Phone:941-417-8300
Mailing Address - Fax:941-417-8301
Practice Address - Street 1:FYZICAL LAKEWOOD RANCH
Practice Address - Street 2:5860 RANCH LAKE BLVD #102
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202
Practice Address - Country:US
Practice Address - Phone:941-417-8300
Practice Address - Fax:941-417-8301
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY9362UMedicare ID - Type UnspecifiedMEDICARE
FLY9362Medicare PIN