Provider Demographics
NPI:1275679870
Name:FOX, LISA M
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:FOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 W HORATIO ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3939
Mailing Address - Country:US
Mailing Address - Phone:813-453-2217
Mailing Address - Fax:813-433-5210
Practice Address - Street 1:4002 W HORATIO ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3939
Practice Address - Country:US
Practice Address - Phone:813-453-2217
Practice Address - Fax:813-433-5210
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist