Provider Demographics
NPI:1851414171
Name:FOSSETT, LISA ANNE (MPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:FOSSETT
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 1:8371 N MILITARY TRL
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-6300
Mailing Address - Country:US
Mailing Address - Phone:561-328-9298
Mailing Address - Fax:
Practice Address - Street 1:8371 N MILITARY TRL
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33410-6300
Practice Address - Country:US
Practice Address - Phone:561-328-9298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23261225100000X
VA2305205027225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFL722ZMedicare PIN