Provider Demographics
NPI:1548636806
Name:IAEGER, LIESL B (PT, DPT)
Entity type:Individual
Prefix:
First Name:LIESL
Middle Name:B
Last Name:IAEGER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W GUADALUPE RD SUITE 313
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233
Mailing Address - Country:US
Mailing Address - Phone:480-892-0808
Mailing Address - Fax:480-892-6045
Practice Address - Street 1:201 W GUADALUPE RD STE 313
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-3334
Practice Address - Country:US
Practice Address - Phone:480-892-0808
Practice Address - Fax:480-890-6045
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11775PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist