Provider Demographics
NPI:1720147226
Name:JOB, TRISA (PT)
Entity type:Individual
Prefix:MS
First Name:TRISA
Middle Name:
Last Name:JOB
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TRISA
Other - Middle Name:
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:35902 HWY 27
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-3737
Mailing Address - Country:US
Mailing Address - Phone:863-421-1777
Mailing Address - Fax:863-421-7070
Practice Address - Street 1:35902 HWY 27
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-3737
Practice Address - Country:US
Practice Address - Phone:863-421-1777
Practice Address - Fax:863-421-7070
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32381225100000X
NY028431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist