Provider Demographics
NPI:1659326924
Name:LISI, CARA LYNN (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:CARA
Middle Name:LYNN
Last Name:LISI
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 1:222 GATEWAY RD
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2902
Mailing Address - Country:US
Mailing Address - Phone:201-444-7416
Mailing Address - Fax:
Practice Address - Street 1:219 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:NJ
Practice Address - Zip Code:07646-2517
Practice Address - Country:US
Practice Address - Phone:201-907-3150
Practice Address - Fax:201-907-3155
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00845900225100000X
NY020026-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist