Provider Demographics
NPI:1093803074
Name:KOSS, LISA ELLEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ELLEN
Last Name:KOSS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:ELLEN
Other - Last Name:WASCHLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:8240 W CACTUS RD
Mailing Address - Street 2:STE 110
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5231
Mailing Address - Country:US
Mailing Address - Phone:623-878-9696
Mailing Address - Fax:623-776-0668
Practice Address - Street 1:8240 W. CACTUS ROAD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381
Practice Address - Country:US
Practice Address - Phone:623-878-9696
Practice Address - Fax:623-776-0668
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5402225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist