Provider Demographics
NPI:1154944825
Name:GARCIA-FRONTELA, LISSETTE (LMT)
Entity type:Individual
Prefix:
First Name:LISSETTE
Middle Name:
Last Name:GARCIA-FRONTELA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5811 MEMORIAL HWY STE 104
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-5000
Mailing Address - Country:US
Mailing Address - Phone:813-513-8880
Mailing Address - Fax:813-513-8881
Practice Address - Street 1:5811 MEMORIAL HWY STE 104
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-5000
Practice Address - Country:US
Practice Address - Phone:813-513-8880
Practice Address - Fax:813-513-8881
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA60610225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist