Provider Demographics
NPI:1003387614
Name:SMILEY, LISA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SMILEY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 W 96TH ST STE 105A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-2920
Mailing Address - Country:US
Mailing Address - Phone:317-660-1999
Mailing Address - Fax:317-660-1870
Practice Address - Street 1:4340 W 96TH ST STE 105A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2920
Practice Address - Country:US
Practice Address - Phone:317-660-1999
Practice Address - Fax:317-660-1870
Is Sole Proprietor?:No
Enumeration Date:2018-12-07
Last Update Date:2018-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05011745A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist