Provider Demographics
NPI:1043007529
Name:LOURENCO, LISA ANN (LMT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:LOURENCO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:PAWLOSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:520 MARSEILLE PATH
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1315
Mailing Address - Country:US
Mailing Address - Phone:631-742-0818
Mailing Address - Fax:
Practice Address - Street 1:520 MARSEILLE PATH
Practice Address - Street 2:
Practice Address - City:SAYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11782-1315
Practice Address - Country:US
Practice Address - Phone:631-742-0818
Practice Address - Fax:631-742-0818
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022970-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist