Most Relevant Information
Provider Data
| NPI Number: | 1003485517 |
| Provider Name: | LISA XAYASONE |
| Entity Type: | Individual |
| Taxonomy Code: | 225200000X |
| Specialty: | Physical Therapy Assistant |
| License Number: | 11802 |
Most Important Dates
| Enumeration Date: | 06/18/2021 |
| Last Updated: | 06/18/2021 |
Provider Practice Location
1806 MAPLELEAF BLVD
OLDSMAR
FL
346772732
Practice Location Phone/Fax
| Phone: | 7372445391 |
| Fax: |
Provider Mailing Location
10133 SHERRILL BLVD STE 200
KNOXVILLE
TN
379323347
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |