Provider Demographics
NPI:1528454931
Name:HARRIS-DALTON, LISA LYNN (LMT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LYNN
Last Name:HARRIS-DALTON
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 1:428 WATERFORD CIR W
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34688-7242
Mailing Address - Country:US
Mailing Address - Phone:727-946-7822
Mailing Address - Fax:
Practice Address - Street 1:428 WATERFORD CIR W
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34688-7242
Practice Address - Country:US
Practice Address - Phone:727-946-7822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA27502225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist