Provider Demographics
NPI:1720058035
Name:FRUSCELLA, LISA M (LMT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:FRUSCELLA
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 1:11001 NW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-8208
Mailing Address - Country:US
Mailing Address - Phone:954-243-7090
Mailing Address - Fax:954-343-5989
Practice Address - Street 1:11001 NW 40TH ST
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-8208
Practice Address - Country:US
Practice Address - Phone:954-243-7090
Practice Address - Fax:954-343-5989
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44817175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath