Provider Demographics
NPI:1174745491
Name:WARNER, LISA N (LMT, CNMT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:N
Last Name:WARNER
Suffix:
Gender:F
Credentials:LMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SUNSHINE BLVD.
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-8705
Mailing Address - Country:US
Mailing Address - Phone:561-795-0626
Mailing Address - Fax:
Practice Address - Street 1:11388 OKEECHOBEE BLVD.
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH.
Practice Address - State:FL
Practice Address - Zip Code:33411-8705
Practice Address - Country:US
Practice Address - Phone:561-789-2310
Practice Address - Fax:561-798-2477
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA37112225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist