Provider Demographics
NPI:1730483884
Name:SHEEHAN, LISA S (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:S
Last Name:SHEEHAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:S
Other - Last Name:DYWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 404
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2915
Mailing Address - Country:US
Mailing Address - Phone:219-836-2995
Mailing Address - Fax:219-836-4075
Practice Address - Street 1:1545 W US HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1562
Practice Address - Country:US
Practice Address - Phone:219-836-5381
Practice Address - Fax:219-836-4466
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003615A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist