Provider Demographics
NPI:1881171585
Name:MANLEY, LISA (DPT)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:MANLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6 GLEN COVE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-4273
Mailing Address - Country:US
Mailing Address - Phone:207-921-6395
Mailing Address - Fax:207-921-6378
Practice Address - Street 1:6 GLEN COVE DRIVE, PBMC
Practice Address - Street 2:
Practice Address - City:ROCKPORT, ME
Practice Address - State:ME
Practice Address - Zip Code:04856
Practice Address - Country:US
Practice Address - Phone:207-921-6395
Practice Address - Fax:207-921-6378
Is Sole Proprietor?:No
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT30632251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics