Provider Demographics
NPI:1174659981
Name:LISA PERUGINI AND ASSOCIATES P.C.
Entity Type:Organization
Organization Name:LISA PERUGINI AND ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELISABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PERUGINI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:570-288-1734
Mailing Address - Street 1:1150 WYOMING AVE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:WYOMING
Mailing Address - State:PA
Mailing Address - Zip Code:18644-1366
Mailing Address - Country:US
Mailing Address - Phone:570-288-1734
Mailing Address - Fax:570-288-1735
Practice Address - Street 1:1150 WYOMING AVE
Practice Address - Street 2:SUITE 700
Practice Address - City:WYOMING
Practice Address - State:PA
Practice Address - Zip Code:18644-1366
Practice Address - Country:US
Practice Address - Phone:570-288-1734
Practice Address - Fax:570-288-1735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0162092251P0200X
PAOC009088225XP0200X
PASL008504235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
Not Answered225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014396680001Medicaid