Provider Demographics
NPI:1649517152
Name:GIUSTY, LISA M (DPT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:GIUSTY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 LARKSPUR LN STE T
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-1043
Mailing Address - Country:US
Mailing Address - Phone:530-605-4422
Mailing Address - Fax:530-722-4289
Practice Address - Street 1:3197 COURTFIELD DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-4804
Practice Address - Country:US
Practice Address - Phone:248-299-2560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501015464225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist