Provider Demographics
NPI:1770650293
Name:KNAUFF, LISA ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:KNAUFF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:PUGLIESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:704 BUCK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-9567
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:204 EAGLE VALLEY MALL
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-1315
Practice Address - Country:US
Practice Address - Phone:570-424-1706
Practice Address - Fax:570-424-6711
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT005699L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2784978000OtherINDEPENDENCE BLUE CROSS
PA50065516OtherCAPITAL BLUE CROSS
PA1917290OtherBLUE SHIELD
PA820837OtherFIRST PRIORITY HEALTH