Provider Demographics
NPI:1861716193
Name:CORSA, LISA
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:CORSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1270 SW 13TH DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-5365
Mailing Address - Country:US
Mailing Address - Phone:561-302-8554
Mailing Address - Fax:561-368-5082
Practice Address - Street 1:1270 SW 13TH DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-5365
Practice Address - Country:US
Practice Address - Phone:561-302-8554
Practice Address - Fax:561-368-5082
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 16373225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist