Provider Demographics
NPI:1467574301
Name:HOROWITZ, LISA M (MPT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:HOROWITZ
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 W NECK RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2621
Mailing Address - Country:US
Mailing Address - Phone:516-983-2905
Mailing Address - Fax:
Practice Address - Street 1:3 TECHNOLOGY DR
Practice Address - Street 2:SUITE 400
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-4064
Practice Address - Country:US
Practice Address - Phone:631-751-8000
Practice Address - Fax:631-751-8030
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025258-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist