Provider Demographics
NPI:1528424132
Name:FORSYTHE, LISA (DIPLOM, LAC)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:FORSYTHE
Suffix:
Gender:F
Credentials:DIPLOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 N. U.S. HWY 441
Mailing Address - Street 2:SUITE 1106
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159
Mailing Address - Country:US
Mailing Address - Phone:352-391-9266
Mailing Address - Fax:352-391-9267
Practice Address - Street 1:1250 W. EAU GALLIE BLVD.
Practice Address - Street 2:SUITE H
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935
Practice Address - Country:US
Practice Address - Phone:321-757-9731
Practice Address - Fax:321-757-5069
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP761171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist