Provider Demographics
NPI:1649561127
Name:DAVINI, LISE A (MSPT)
Entity Type:Individual
Prefix:
First Name:LISE
Middle Name:A
Last Name:DAVINI
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03781-0311
Mailing Address - Country:US
Mailing Address - Phone:603-650-8628
Mailing Address - Fax:
Practice Address - Street 1:1142 ROUTE 12A
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NH
Practice Address - Zip Code:03781-5050
Practice Address - Country:US
Practice Address - Phone:603-650-8628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist