Provider Demographics
NPI:1295758647
Name:PLECKI, LISA A (RT(R)(M),CRT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:PLECKI
Suffix:
Gender:F
Credentials:RT(R)(M),CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3765 SHADY RUN RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32934-8547
Mailing Address - Country:US
Mailing Address - Phone:321-446-5379
Mailing Address - Fax:
Practice Address - Street 1:1340 MEDICAL PARK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3246
Practice Address - Country:US
Practice Address - Phone:321-729-9493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCRT 243972471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography