Provider Demographics
NPI:1144334657
Name:LISAY, LIZA M (PT)
Entity type:Individual
Prefix:MS
First Name:LIZA
Middle Name:M
Last Name:LISAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:BROOKEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20833-0500
Mailing Address - Country:US
Mailing Address - Phone:301-728-4309
Mailing Address - Fax:410-654-8709
Practice Address - Street 1:14235 PARK CENTER DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5261
Practice Address - Country:US
Practice Address - Phone:301-498-8100
Practice Address - Fax:301-498-0009
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT870220225100000X
MD21320225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC016565P52Medicare ID - Type UnspecifiedPHYSICAL THERAPY
Q37992Medicare UPIN