Provider Demographics
NPI:1144841883
Name:LEPINE, LISA MARIE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:LEPINE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 COUNTY ROUTE 63
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-5100
Mailing Address - Country:US
Mailing Address - Phone:315-529-8724
Mailing Address - Fax:
Practice Address - Street 1:1495 S VOLUSIA AVE STE 101
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-7047
Practice Address - Country:US
Practice Address - Phone:386-401-6100
Practice Address - Fax:386-960-0551
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL35628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty