Provider Demographics
NPI:1710942578
Name:LISSY, CHERYL (PT,ATC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:LISSY
Suffix:
Gender:F
Credentials:PT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 LANTANA DR
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-8805
Mailing Address - Country:US
Mailing Address - Phone:302-239-2800
Mailing Address - Fax:302-239-7500
Practice Address - Street 1:216 LANTANA DR
Practice Address - Street 2:
Practice Address - City:HOCKESSIN
Practice Address - State:DE
Practice Address - Zip Code:19707-8805
Practice Address - Country:US
Practice Address - Phone:302-239-2800
Practice Address - Fax:302-239-7500
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-00013552251S0007X
PA04-4759722251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports