Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 022371 | NY |
NPI | 1730202128 |
---|---|
Provider Name | Mrs. Lisa Marie Denisco |
First Address | East Northport, NY 11731 |
Second Address | East Northport, NY 11731 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2007 |
Last Update Date | 23/03/2015 |