Provider Demographics
NPI:1689870180
Name:AMODEO, LISA J (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:AMODEO
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 1:83 BUTTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:S ROYALTON
Mailing Address - State:VT
Mailing Address - Zip Code:05068-5224
Mailing Address - Country:US
Mailing Address - Phone:802-889-3245
Mailing Address - Fax:
Practice Address - Street 1:49 CEDAR HILL LN
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:VT
Practice Address - Zip Code:05089
Practice Address - Country:US
Practice Address - Phone:802-674-6609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0400003008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist