Provider Demographics
NPI:1780706697
Name:TOMASELLI, LISA ANN (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:TOMASELLI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 BEACHVIEW ST
Mailing Address - Street 2:SUITE #120
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3700
Mailing Address - Country:US
Mailing Address - Phone:214-324-5851
Mailing Address - Fax:214-324-5728
Practice Address - Street 1:1130 BEACHVIEW ST
Practice Address - Street 2:SUITE #120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3700
Practice Address - Country:US
Practice Address - Phone:214-324-5851
Practice Address - Fax:214-324-5728
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1106383174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist