Provider Demographics
NPI:1821297417
Name:LIZASO, ARTHUR (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:LIZASO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 HYLAN BLVD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-6322
Mailing Address - Country:US
Mailing Address - Phone:718-227-0198
Mailing Address - Fax:
Practice Address - Street 1:4870 HYLAN BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10312-6322
Practice Address - Country:US
Practice Address - Phone:718-356-1337
Practice Address - Fax:718-356-1337
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011812-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ1989ZZQW1Medicare PIN