Provider Demographics
NPI:1245292465
Name:COTTRILL, LISA LEE (LPT)
Entity type:Individual
Prefix:MISS
First Name:LISA
Middle Name:LEE
Last Name:COTTRILL
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 LONITA ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-2605
Mailing Address - Country:US
Mailing Address - Phone:336-323-1440
Mailing Address - Fax:
Practice Address - Street 1:5314 W FRIENDLY AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4351
Practice Address - Country:US
Practice Address - Phone:336-834-9740
Practice Address - Fax:336-297-9061
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist