Provider Demographics
NPI:1902991268
Name:COORS, LISA A (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:COORS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:226 SEVENTH STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-747-1520
Mailing Address - Fax:516-747-1552
Practice Address - Street 1:226 SEVENTH STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-747-1520
Practice Address - Fax:516-747-1552
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY0229111225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
02692684Medicare ID - Type Unspecified
Q22H71Medicare ID - Type Unspecified