Provider Demographics
NPI:1063615953
Name:SCHNEIDER, LISA D (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:SCHNEIDER
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:10505 19TH AVE SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-4280
Mailing Address - Country:US
Mailing Address - Phone:408-570-0510
Mailing Address - Fax:408-945-4018
Practice Address - Street 1:3726 BROADWAY
Practice Address - Street 2:#104
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-3787
Practice Address - Country:US
Practice Address - Phone:425-252-4600
Practice Address - Fax:425-252-4477
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2013-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WA00003569225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1001668Medicaid
WAG8914014OtherMEDICARE PIN/ CASCADE REHABILITATION ASSOCIATES, LLC
WAG8914015OtherMEDICARE PIN/ SUMMIT REHABILITATION