Provider Demographics
NPI:1891017760
Name:PURDY, LISA R (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:R
Last Name:PURDY
Suffix:
Gender:F
Credentials:PT
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:124 US ROUTE 11
Mailing Address - Street 2:KUSS PHYSICAL THERAPY
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036-9760
Mailing Address - Country:US
Mailing Address - Phone:315-668-0123
Mailing Address - Fax:315-668-0124
Practice Address - Street 1:124 US ROUTE 11
Practice Address - Street 2:KUSS PHYSICAL THERAPY
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036-9760
Practice Address - Country:US
Practice Address - Phone:315-668-0123
Practice Address - Fax:315-668-0124
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014533-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0291Medicare UPIN