Provider Demographics
NPI:1790920726
Name:COOLEY, LISA MICHELE (LMT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:MICHELE
Last Name:COOLEY
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 1:1807 KIM ACRES LN
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:FL
Mailing Address - Zip Code:33527-6011
Mailing Address - Country:US
Mailing Address - Phone:813-657-2233
Mailing Address - Fax:
Practice Address - Street 1:1804 W BAKER ST
Practice Address - Street 2:SUITE F
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-2900
Practice Address - Country:US
Practice Address - Phone:813-719-1963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA43897225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA43897OtherSTATE OF FLORIDA LICENSE NUMBER