Provider Demographics
NPI:1760880108
Name:LOLLIS, LISA (DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LOLLIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:COLOMBO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:118 PORTSMOUTH AVE STE B101
Mailing Address - Street 2:
Mailing Address - City:STRATHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03885-4434
Mailing Address - Country:US
Mailing Address - Phone:603-580-4494
Mailing Address - Fax:603-580-4495
Practice Address - Street 1:51 WEBB PL STE 320
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2463
Practice Address - Country:US
Practice Address - Phone:603-834-9116
Practice Address - Fax:603-834-9123
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-17
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305209189225100000X
NC15369225100000X
NH3809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist