Provider Demographics
NPI:1609012491
Name:JEFFREY, LISA ANN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:JEFFREY
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 2420
Mailing Address - Street 2:
Mailing Address - City:SAINT LEO
Mailing Address - State:FL
Mailing Address - Zip Code:33574-2420
Mailing Address - Country:US
Mailing Address - Phone:813-838-1787
Mailing Address - Fax:352-437-4059
Practice Address - Street 1:32675 PENNSYLVANIA AVE.
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:FL
Practice Address - Zip Code:33576
Practice Address - Country:US
Practice Address - Phone:813-838-1787
Practice Address - Fax:352-437-4059
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-28
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 55167225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist