Provider Demographics
NPI:1699774356
Name:BETTIO, LISA MARIE (MSRPT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:BETTIO
Suffix:
Gender:F
Credentials:MSRPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8872 FORD AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-6092
Mailing Address - Country:US
Mailing Address - Phone:912-312-2766
Mailing Address - Fax:
Practice Address - Street 1:8872 FORD AVE STE 206
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:GA
Practice Address - Zip Code:31324-6092
Practice Address - Country:US
Practice Address - Phone:912-312-2766
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA650025450OtherRR MEDICARE
GA853202OtherBCBS
P77624Medicare UPIN
GA65BBBWZMedicare ID - Type Unspecified