Provider Demographics
NPI:1275655334
Name:CANFIELD, LISA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1747 RUNNING DEER DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:PA
Mailing Address - Zip Code:17922-9333
Mailing Address - Country:US
Mailing Address - Phone:570-739-3635
Mailing Address - Fax:
Practice Address - Street 1:125 HOLLY RD
Practice Address - Street 2:
Practice Address - City:HAMBURG
Practice Address - State:PA
Practice Address - Zip Code:19526-8729
Practice Address - Country:US
Practice Address - Phone:610-562-2284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE-001212L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant