Provider Demographics
NPI:1750406104
Name:SPRAGUE, LISA HELEN (MSS, PTA, LMT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:HELEN
Last Name:SPRAGUE
Suffix:
Gender:F
Credentials:MSS, PTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 CEDAR SPRINGS DR APT 201
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-2372
Mailing Address - Country:US
Mailing Address - Phone:239-821-1223
Mailing Address - Fax:
Practice Address - Street 1:9051 TAMIAMI TRL N STE 101
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34108-2520
Practice Address - Country:US
Practice Address - Phone:239-594-5440
Practice Address - Fax:239-594-7547
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA-858225200000X
FLMA-21469225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist