Provider Demographics
NPI:1558523001
Name:LIS, ANGELA MARIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIA
Last Name:LIS
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:955 S SPRINGFIELD AVE
Mailing Address - Street 2:PARK PLACE #806
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-3543
Mailing Address - Country:US
Mailing Address - Phone:212-568-1552
Mailing Address - Fax:212-255-6754
Practice Address - Street 1:63 DOWNING ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-4331
Practice Address - Country:US
Practice Address - Phone:212-255-6690
Practice Address - Fax:212-255-6754
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY022758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist