Provider Demographics
NPI:1508490301
Name:VISCUSO, LISA ANN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:VISCUSO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 COOPERSTOWN CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-1328
Mailing Address - Country:US
Mailing Address - Phone:410-967-4865
Mailing Address - Fax:
Practice Address - Street 1:13 COOPERSTOWN CT
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:MD
Practice Address - Zip Code:21131-1328
Practice Address - Country:US
Practice Address - Phone:410-967-4865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist