Provider Demographics
NPI:1134362973
Name:STANDWILL, LISA M (PT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:STANDWILL
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 1:12 SKIPPER DR
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-5030
Mailing Address - Country:US
Mailing Address - Phone:631-587-2831
Mailing Address - Fax:
Practice Address - Street 1:12 SKIPPER DR
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-5030
Practice Address - Country:US
Practice Address - Phone:631-587-2831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-09
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013903225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist