Provider Demographics
NPI:1609287671
Name:PERETICH COLE, LISA ROBIN (DPT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ROBIN
Last Name:PERETICH COLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:ROBIN
Other - Last Name:PERETICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 248
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:PA
Mailing Address - Zip Code:16346-0248
Mailing Address - Country:US
Mailing Address - Phone:814-670-0534
Mailing Address - Fax:814-670-0653
Practice Address - Street 1:4247 W RIDGE RD STE 104
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-1746
Practice Address - Country:US
Practice Address - Phone:814-833-7249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT023058225100000X
MD24719225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist