Provider Demographics
NPI:1033498985
Name:LIZARDI, TYLENE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:TYLENE
Middle Name:
Last Name:LIZARDI
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 1:126 MAIN ST STE 2B
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1525
Mailing Address - Country:US
Mailing Address - Phone:845-663-7427
Mailing Address - Fax:
Practice Address - Street 1:100 WOODLAND POND CIR
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-6405
Practice Address - Country:US
Practice Address - Phone:845-256-5955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0304661225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist