Provider Demographics
NPI:1336526854
Name:MAGLIARDITI, LISA (DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MAGLIARDITI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4003 S WEST SHORE BLVD APT 4714
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-1040
Mailing Address - Country:US
Mailing Address - Phone:716-258-0367
Mailing Address - Fax:
Practice Address - Street 1:12110 MORRIS BRIGE ROAD
Practice Address - Street 2:3RD FLOOR THERAPY SUITE
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637
Practice Address - Country:US
Practice Address - Phone:813-550-1212
Practice Address - Fax:813-867-7177
Is Sole Proprietor?:No
Enumeration Date:2015-05-05
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL34086225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist