Provider Demographics
NPI:1508825936
Name:MARKLEY, LISA J (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:J
Last Name:MARKLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:J
Other - Last Name:PINKELMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:154 S LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1314
Mailing Address - Country:US
Mailing Address - Phone:313-220-0425
Mailing Address - Fax:
Practice Address - Street 1:23550 PARK ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-2592
Practice Address - Country:US
Practice Address - Phone:313-730-0500
Practice Address - Fax:313-730-0600
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501003906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI10951OtherMCARE
MI30374OtherBCBS
236613Medicare ID - Type Unspecified