Provider Demographics
NPI:1730444522
Name:LISK, MATTHEW (ATC, DPT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:LISK
Suffix:
Gender:M
Credentials:ATC, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:166 SPRINGBROOK AVE STE 201
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-8520
Practice Address - Country:US
Practice Address - Phone:828-492-0592
Practice Address - Fax:410-648-4878
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP13758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist