Provider Demographics
NPI:1104884196
Name:JARRIEL, LISA SLAY (PTA)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:SLAY
Last Name:JARRIEL
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 1:2457 SW 9TH LANE
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974
Mailing Address - Country:US
Mailing Address - Phone:863-467-6669
Mailing Address - Fax:863-467-6674
Practice Address - Street 1:332 SW 32ND STREET
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974
Practice Address - Country:US
Practice Address - Phone:863-467-6669
Practice Address - Fax:863-467-6674
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19185225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant