Provider Demographics
NPI:1720590540
Name:WEISS, LISA M (PT, DPT, ATC, CSCS)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:M
Last Name:WEISS
Suffix:
Gender:F
Credentials:PT, DPT, ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:780 US 1 UNIT 201
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962-1662
Mailing Address - Country:US
Mailing Address - Phone:772-567-7777
Mailing Address - Fax:
Practice Address - Street 1:780 US 1 UNIT 201
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962-1662
Practice Address - Country:US
Practice Address - Phone:772-567-7777
Practice Address - Fax:772-567-7777
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT33166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist