Provider Demographics
NPI:1366690786
Name:SWEET, LISA R (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:R
Last Name:SWEET
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:D
Other - Last Name:RENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:809 TREMONT DR
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-4131
Mailing Address - Country:US
Mailing Address - Phone:610-269-3774
Mailing Address - Fax:
Practice Address - Street 1:3000 CG ZINN ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372
Practice Address - Country:US
Practice Address - Phone:610-383-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-28
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT019349174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist