Provider Demographics
NPI:1831419241
Name:FIFE, LISA R (SL/P)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:FIFE
Suffix:
Gender:F
Credentials:SL/P
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:R
Other - Last Name:ROWE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SL/P
Mailing Address - Street 1:10 MARKET PLACE DR
Mailing Address - Street 2:#3B
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1680
Mailing Address - Country:US
Mailing Address - Phone:207-351-3078
Mailing Address - Fax:207-351-3083
Practice Address - Street 1:10 MARKET PLACE DR
Practice Address - Street 2:#3B
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1680
Practice Address - Country:US
Practice Address - Phone:207-351-3078
Practice Address - Fax:207-351-3083
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist