Provider Demographics
NPI:1851589337
Name:TONEY, LISA M (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:TONEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:SORENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2101 NW PROFESSIONAL DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3888
Mailing Address - Country:US
Mailing Address - Phone:541-752-0545
Mailing Address - Fax:541-757-0545
Practice Address - Street 1:2101 NW PROFESSIONAL DR
Practice Address - Street 2:SUITE 2
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3888
Practice Address - Country:US
Practice Address - Phone:541-752-0545
Practice Address - Fax:541-757-0545
Is Sole Proprietor?:No
Enumeration Date:2007-10-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3690225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR831588000OtherBLUE CROSS BLUE SHIELD
OR831588000OtherBLUE CROSS BLUE SHIELD