Provider Demographics
NPI:1912106196
Name:DAIGLE, LISA A (RPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 ROSANNE ST
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-5930
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1157 HIGHLAND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-1600
Practice Address - Country:US
Practice Address - Phone:187-727-1928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003810225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist