Provider Demographics
NPI:1003941592
Name:GOODFRIEND, LISA HOPE (MPT, CWS, FCCWS)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:HOPE
Last Name:GOODFRIEND
Suffix:
Gender:F
Credentials:MPT, CWS, FCCWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 BRIDLE PATH
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2740
Mailing Address - Country:US
Mailing Address - Phone:410-707-9891
Mailing Address - Fax:
Practice Address - Street 1:7TH AND CLAYTON STREETS
Practice Address - Street 2:ST. FRANCES WOUND CARE CENTER, SUITE 601 MSB
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19805
Practice Address - Country:US
Practice Address - Phone:302-575-8180
Practice Address - Fax:302-575-8185
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD192682251E1300X
DEJ1-00020842251E1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, Clinical