Provider Demographics
NPI:1801076377
Name:ERICKSON-ZINTER, LISA GAYLE (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:GAYLE
Last Name:ERICKSON-ZINTER
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 1:54 JENSEN ST
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9296
Mailing Address - Country:US
Mailing Address - Phone:413-323-6013
Mailing Address - Fax:
Practice Address - Street 1:30 OLD LYMAN RD
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-2630
Practice Address - Country:US
Practice Address - Phone:413-533-7140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6525225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist