Provider Demographics
NPI:1922017227
Name:TOMNITZ, LISA M (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:TOMNITZ
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 1:1825 E BOISE ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-8213
Mailing Address - Country:US
Mailing Address - Phone:602-499-4647
Mailing Address - Fax:480-813-7901
Practice Address - Street 1:2940 E BANNER GATEWAY DR
Practice Address - Street 2:SUITE 425
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2168
Practice Address - Country:US
Practice Address - Phone:480-813-7900
Practice Address - Fax:480-813-7901
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ106154Medicare ID - Type Unspecified