Provider Demographics
NPI:1598979874
Name:MERRILL, LISSA B (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISSA
Middle Name:B
Last Name:MERRILL
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 1:16 PINETREE LN
Mailing Address - Street 2:
Mailing Address - City:WEST PARIS
Mailing Address - State:ME
Mailing Address - Zip Code:04289-5111
Mailing Address - Country:US
Mailing Address - Phone:207-674-2195
Mailing Address - Fax:
Practice Address - Street 1:181 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWAY
Practice Address - State:ME
Practice Address - Zip Code:04268-5664
Practice Address - Country:US
Practice Address - Phone:207-743-5933
Practice Address - Fax:207-743-1577
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist