Provider Demographics
NPI:1821288481
Name:MANSER, LISA (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:MANSER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 SUSSEX RD
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2511
Mailing Address - Country:US
Mailing Address - Phone:201-871-1429
Mailing Address - Fax:201-871-3956
Practice Address - Street 1:91 SUSSEX RD
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-2511
Practice Address - Country:US
Practice Address - Phone:201-871-1429
Practice Address - Fax:201-871-3956
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00243200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist