Provider Demographics
NPI:1598970501
Name:FRESSO-DOYLE, LOIS (PT)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:FRESSO-DOYLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:760 FORT PRINCE BLVD
Mailing Address - Street 2:
Mailing Address - City:WELLFORD
Mailing Address - State:SC
Mailing Address - Zip Code:29385-9770
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:760 FORT PRINCE BLVD
Practice Address - Street 2:
Practice Address - City:WELLFORD
Practice Address - State:SC
Practice Address - Zip Code:29385-9770
Practice Address - Country:US
Practice Address - Phone:630-779-8414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.005749225100000X
SC.94852251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics