Provider Demographics
NPI:1174737829
Name:DONNELLY, LISA C (PT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:C
Last Name:DONNELLY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 892
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:FL
Mailing Address - Zip Code:32617-0892
Mailing Address - Country:US
Mailing Address - Phone:352-629-3279
Mailing Address - Fax:
Practice Address - Street 1:2210 SE 17TH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-9144
Practice Address - Country:US
Practice Address - Phone:352-629-4509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT2290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist