Provider Demographics
NPI:1821152257
Name:GILL PRAY, LISSA L
Entity Type:Individual
Prefix:
First Name:LISSA
Middle Name:L
Last Name:GILL PRAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 HIGHWAY 25B NORTH
Mailing Address - Street 2:SUITE A1
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-6417
Mailing Address - Country:US
Mailing Address - Phone:501-362-7195
Mailing Address - Fax:501-362-7855
Practice Address - Street 1:2000 HIGHWAY 25B
Practice Address - Street 2:SUITE A1
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-6417
Practice Address - Country:US
Practice Address - Phone:501-362-7195
Practice Address - Fax:501-362-7855
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT720225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000239889OtherPERSONAL HMSA, BCBS NUMBE
HIH55366Medicare UPIN