Provider Demographics
NPI:1407289002
Name:WEEKS, LISA DANIELLE (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DANIELLE
Last Name:WEEKS
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 1:325 ROLLING OAKS DRIVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1088
Mailing Address - Country:US
Mailing Address - Phone:805-446-3141
Mailing Address - Fax:805-446-3140
Practice Address - Street 1:325 ROLLING OAKS DR
Practice Address - Street 2:SUITE 210
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-1201
Practice Address - Country:US
Practice Address - Phone:805-446-3141
Practice Address - Fax:805-446-3140
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT404072251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT40407OtherPT LICENSE
CAPT40407OtherPT LICENSE