Provider Demographics
NPI:1609925999
Name:MASCALL, LISA ANNE (PT, LAC)
Entity Type:Individual
Prefix:
First Name:LISA ANNE
Middle Name:
Last Name:MASCALL
Suffix:
Gender:F
Credentials:PT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CLINTON PL
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-4579
Mailing Address - Country:US
Mailing Address - Phone:201-561-1240
Mailing Address - Fax:
Practice Address - Street 1:50 CLINTON PL
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-4579
Practice Address - Country:US
Practice Address - Phone:201-561-1240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005836171100000X
NY027805-01225100000X
NJ40QA01027200225100000X
NJ25MZ00130000171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ082639MYEMedicare ID - Type Unspecified