Provider Demographics
NPI:1619545837
Name:GREENFIELD, LISA ELLEN (LAT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ELLEN
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1787 E GROVEHILL RD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-3923
Mailing Address - Country:US
Mailing Address - Phone:727-614-2019
Mailing Address - Fax:
Practice Address - Street 1:1787 E GROVEHILL RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-3923
Practice Address - Country:US
Practice Address - Phone:727-614-2019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL42802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer