Provider Demographics
NPI:1003987603
Name:AMES, LISA M (PTA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:AMES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:AMES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:34 INDEPENDENCE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-2236
Mailing Address - Country:US
Mailing Address - Phone:732-766-9403
Mailing Address - Fax:
Practice Address - Street 1:175 BARTLEY RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-1241
Practice Address - Country:US
Practice Address - Phone:732-766-9403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00143600225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant