Provider Demographics
NPI:1144595877
Name:MAXEY, LISA YVONNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:YVONNE
Last Name:MAXEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29937 QUAIL RUN DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4066
Mailing Address - Country:US
Mailing Address - Phone:818-706-1954
Mailing Address - Fax:
Practice Address - Street 1:450 ROSEWOOD AVE STE 105
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-5914
Practice Address - Country:US
Practice Address - Phone:805-389-4781
Practice Address - Fax:805-389-4725
Is Sole Proprietor?:No
Enumeration Date:2012-03-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16313225100000X
CAPT 16313225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist