Provider Demographics
NPI:1578015996
Name:LAPUZ, LIZELLE (PTA)
Entity Type:Individual
Prefix:
First Name:LIZELLE
Middle Name:
Last Name:LAPUZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 PONTE VEDRA PARK DR
Mailing Address - Street 2:STE 300
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32082-6619
Mailing Address - Country:US
Mailing Address - Phone:904-280-3440
Mailing Address - Fax:904-280-3444
Practice Address - Street 1:236 PONTE VEDRA PARK DR
Practice Address - Street 2:SUITE 300
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32082-6619
Practice Address - Country:US
Practice Address - Phone:904-280-3440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA26737225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant