Provider Demographics
NPI:1699043802
Name:FOURKAS, LISA MARIE-MONE (PT, DPT, CPA (INACTI)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARIE-MONE
Last Name:FOURKAS
Suffix:
Gender:F
Credentials:PT, DPT, CPA (INACTI
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:MONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:862 QUETTA AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-1254
Mailing Address - Country:US
Mailing Address - Phone:408-830-9761
Mailing Address - Fax:
Practice Address - Street 1:1601 SOUTH DEANZA BLVD
Practice Address - Street 2:SUITE 111
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014
Practice Address - Country:US
Practice Address - Phone:408-257-2225
Practice Address - Fax:408-257-2485
Is Sole Proprietor?:No
Enumeration Date:2011-12-02
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25938225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist