Provider Demographics
NPI:1124204227
Name:LISI, NANCY JEAN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JEAN
Last Name:LISI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:NANCY
Other - Middle Name:JEAN
Other - Last Name:LISI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:100 TER HEUN DR
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2503
Mailing Address - Country:US
Mailing Address - Phone:508-495-7600
Mailing Address - Fax:
Practice Address - Street 1:1 TROWBRIDGE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:BOURNE
Practice Address - State:MA
Practice Address - Zip Code:02532-3660
Practice Address - Country:US
Practice Address - Phone:508-743-0320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2426225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant