Provider Demographics
NPI:1508852955
Name:CLANCY, LISA (DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CLANCY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 CENTERVILLE RD FL 2
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4394
Mailing Address - Country:US
Mailing Address - Phone:401-732-8200
Mailing Address - Fax:401-732-8230
Practice Address - Street 1:227 CENTERVILLE RD FL 2
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4394
Practice Address - Country:US
Practice Address - Phone:401-732-8200
Practice Address - Fax:401-732-8230
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT00965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI2386488OtherAETNA
RI401342OtherBLUE CHIP
RI103959900OtherDLWC
RI050513332OtherGREATWEST
RI1508852955OtherNPI
RI050513332OtherPHCS
RI213444OtherBLUE CROSS
RI050513332OtherUNITED HEALTHCARE
RI050513332OtherPHCS