Provider Demographics
NPI:1710174131
Name:FELISKO, JANICE LEA (LMT)
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:LEA
Last Name:FELISKO
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 1:555 W GRANADA BLVD STE E10
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-9403
Mailing Address - Country:US
Mailing Address - Phone:386-383-3627
Mailing Address - Fax:
Practice Address - Street 1:555 W GRANADA BLVD STE E10
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-9403
Practice Address - Country:US
Practice Address - Phone:386-383-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-30
Last Update Date:2007-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA50221172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist