Provider Demographics
NPI:1194207951
Name:YOUNG, LISA (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:RIANE
Other - Last Name:WINTERBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3915 GYPSUM LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-5338
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7727 LAKE UNDERHILL RD # 345
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8224
Practice Address - Country:US
Practice Address - Phone:407-303-8626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33877225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist