Provider Demographics
NPI:1780745562
Name:GEORGE, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 SW HIGHWAY 200
Mailing Address - Street 2:SUITE 2001
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34481-9612
Mailing Address - Country:US
Mailing Address - Phone:352-854-4017
Mailing Address - Fax:352-854-4389
Practice Address - Street 1:9401 SW HIGHWAY 200
Practice Address - Street 2:SUITE 2001
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-9612
Practice Address - Country:US
Practice Address - Phone:352-854-4017
Practice Address - Fax:352-854-4389
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0003979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
593705510OtherTAX ID #
FLY2539OtherBCBS
593705510OtherTAX ID #