Provider Demographics
NPI:1780941336
Name:LANZA, SIBILA ORCHARD (PTA)
Entity type:Individual
Prefix:
First Name:SIBILA
Middle Name:ORCHARD
Last Name:LANZA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W LEON LN
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3822
Mailing Address - Country:US
Mailing Address - Phone:321-868-1766
Mailing Address - Fax:
Practice Address - Street 1:119 W LEON LN
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3822
Practice Address - Country:US
Practice Address - Phone:321-868-1766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 18565225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant