Provider Demographics
NPI:1063618692
Name:REID, LISA DIANE (PT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DIANE
Last Name:REID
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3903 ROSEBORO ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-5143
Mailing Address - Country:US
Mailing Address - Phone:540-220-9262
Mailing Address - Fax:
Practice Address - Street 1:395 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34759-4012
Practice Address - Country:US
Practice Address - Phone:407-914-9168
Practice Address - Fax:407-337-8005
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT26791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist