Provider Demographics
NPI:1801282876
Name:CASSIDY, LISA (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CASSIDY
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 1:25 ROCK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:UPPER BLACK EDDY
Mailing Address - State:PA
Mailing Address - Zip Code:18972-9559
Mailing Address - Country:US
Mailing Address - Phone:215-534-6599
Mailing Address - Fax:610-294-7970
Practice Address - Street 1:25 ROCK RIDGE RD
Practice Address - Street 2:
Practice Address - City:UPPER BLACK EDDY
Practice Address - State:PA
Practice Address - Zip Code:18972-9559
Practice Address - Country:US
Practice Address - Phone:215-534-6599
Practice Address - Fax:610-294-7970
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008051L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist