Provider Demographics
NPI:1710043484
Name:LISS, DAN (DPT)
Entity Type:Individual
Prefix:MR
First Name:DAN
Middle Name:
Last Name:LISS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ALTON WAY
Mailing Address - Street 2:
Mailing Address - City:SEWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:08080-3114
Mailing Address - Country:US
Mailing Address - Phone:856-381-7721
Mailing Address - Fax:
Practice Address - Street 1:14 PARKE PLACE BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-2661
Practice Address - Country:US
Practice Address - Phone:856-256-8393
Practice Address - Fax:856-265-8390
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00902500225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2238845000OtherAMERIHEALTH
NJ2439868OtherUNITED HEALTHCARE
NJP00162648OtherRAILROADMCR
NJ077485R5AMedicare ID - Type UnspecifiedMEDICARE