Provider Demographics
NPI:1336170620
Name:CONNIFF, LISA (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CONNIFF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:TARHANICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:509 SECOND AVENUE
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:PA
Mailing Address - Zip Code:18434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:107 NP 502 PLZ
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:PA
Practice Address - Zip Code:18444-9266
Practice Address - Country:US
Practice Address - Phone:570-848-1240
Practice Address - Fax:570-848-1243
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT-011722L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0239015000OtherINDEPENDENCE BLUE CROSS
PA29284OtherBLUE SHIELD
PA5975668OtherAETNA
PA820367OtherFIRST PRIORITY HEALTH
PA50060152OtherCAPITAL BLUE CROSS