Provider Demographics
NPI:1114339066
Name:LISKE, HOLLY (DPT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:LISKE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 N 24TH ST
Mailing Address - Street 2:230
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-6534
Mailing Address - Country:US
Mailing Address - Phone:602-903-4383
Mailing Address - Fax:602-714-5483
Practice Address - Street 1:3700 N 24TH ST
Practice Address - Street 2:230
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-6534
Practice Address - Country:US
Practice Address - Phone:602-903-4383
Practice Address - Fax:602-714-5483
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10860225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist