Provider Demographics
NPI:1780862656
Name:RYSANEK, PAULETTE (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:
Last Name:RYSANEK
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:PAULETTE
Other - Middle Name:
Other - Last Name:BOLSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPTA
Mailing Address - Street 1:7227 LAND O LAKES BLVD
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34638-2826
Mailing Address - Country:US
Mailing Address - Phone:813-794-2000
Mailing Address - Fax:
Practice Address - Street 1:7227 LAND O LAKES BLVD
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-2826
Practice Address - Country:US
Practice Address - Phone:813-794-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2009-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJQB01075225200000X
FL20276225200000X
NY000616-1225200000X
NY004316-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist