Provider Demographics
NPI:1730626763
Name:PAPA, LIZABELLE EDANO (RPT)
Entity type:Individual
Prefix:
First Name:LIZABELLE
Middle Name:EDANO
Last Name:PAPA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 NW 19TH DR
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-1857
Mailing Address - Country:US
Mailing Address - Phone:904-609-6003
Mailing Address - Fax:
Practice Address - Street 1:4110 NW 19TH DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-1857
Practice Address - Country:US
Practice Address - Phone:904-609-6003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-29
Last Update Date:2022-03-22
Deactivation Date:2018-07-02
Deactivation Code:
Reactivation Date:2022-03-22
Provider Licenses
StateLicense IDTaxonomies
FL31287225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist