Provider Demographics
NPI:1073521852
Name:LETTIERE, LISA GALE
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:GALE
Last Name:LETTIERE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:GALE
Other - Last Name:BARICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:8707 SKOKIE BLVD # 402
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2269
Mailing Address - Country:US
Mailing Address - Phone:773-616-7638
Mailing Address - Fax:847-329-8252
Practice Address - Street 1:8707 SKOKIE BLVD # 402
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-2269
Practice Address - Country:US
Practice Address - Phone:773-616-7638
Practice Address - Fax:847-329-8252
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0700058952251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics