Provider Demographics
NPI:1750510475
Name:MICHELANGELO, LISA MICHELE (MPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELE
Last Name:MICHELANGELO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17419 BRIDGE HILL COURT
Mailing Address - Street 2:SUITE C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647
Mailing Address - Country:US
Mailing Address - Phone:813-907-7879
Mailing Address - Fax:813-994-3080
Practice Address - Street 1:17419 BRIDGE HILL CT
Practice Address - Street 2:SUITE C
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-3467
Practice Address - Country:US
Practice Address - Phone:813-907-7879
Practice Address - Fax:813-994-3080
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT17695111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation