Provider Demographics
NPI:1982840401
Name:GREGOIRE, LISA ANNE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANNE
Last Name:GREGOIRE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNE
Other - Last Name:KOUTIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1758 WILI PA LOOP
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793
Mailing Address - Country:US
Mailing Address - Phone:808-243-7870
Mailing Address - Fax:808-243-7871
Practice Address - Street 1:1758 WILI PA LOOP
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793
Practice Address - Country:US
Practice Address - Phone:808-243-7870
Practice Address - Fax:808-243-7871
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2958225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist