Provider Demographics
NPI:1326234683
Name:MEYER, LISA SCHORB (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SCHORB
Last Name:MEYER
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 1:4215 FF RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:IL
Mailing Address - Zip Code:62236-4629
Mailing Address - Country:US
Mailing Address - Phone:618-939-1886
Mailing Address - Fax:618-939-4070
Practice Address - Street 1:4215 FF RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:IL
Practice Address - Zip Code:62236-4629
Practice Address - Country:US
Practice Address - Phone:618-939-1886
Practice Address - Fax:618-939-4070
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01696225100000X
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist