Provider Demographics
NPI:1730486523
Name:PRASSO, LISA GEORGETTE (DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GEORGETTE
Last Name:PRASSO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7166 252ND ST
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-2737
Mailing Address - Country:US
Mailing Address - Phone:917-292-6287
Mailing Address - Fax:
Practice Address - Street 1:11850 NICHOLAS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4476
Practice Address - Country:US
Practice Address - Phone:402-505-4670
Practice Address - Fax:402-505-9753
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9208225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist