Provider Demographics
NPI:1780794875
Name:GARGER, LISE DALY (PT)
Entity type:Individual
Prefix:
First Name:LISE
Middle Name:DALY
Last Name:GARGER
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 1:954 BARCROFT WOODS CT
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63021-6912
Mailing Address - Country:US
Mailing Address - Phone:314-838-9968
Mailing Address - Fax:
Practice Address - Street 1:12266 DEPAUL DRIVE
Practice Address - Street 2:SUITE 115
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-209-7700
Practice Address - Fax:314-209-7705
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003010144225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist