Basic Information
| Provider Information | |||||||||
| NPI: | 1417516873 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITESELL | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | MA72926 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10808 DEERBERRY DR | ||||||||
| Address2: | |||||||||
| City: | LAND O LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346386894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7272477153 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5307 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEW PORT RICHEY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346522536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7279007788 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2019 | ||||||||
| LastUpdateDate: | 06/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | MA72926 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.