Provider Demographics
NPI:1154340370
Name:FOGELMAN, LISA S (DPT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:S
Last Name:FOGELMAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 SWAMP PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19525-9307
Mailing Address - Country:US
Mailing Address - Phone:610-327-2600
Mailing Address - Fax:610-327-9050
Practice Address - Street 1:1806 SWAMP PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:GILBERTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19525-9307
Practice Address - Country:US
Practice Address - Phone:610-327-2600
Practice Address - Fax:610-327-9050
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017982225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA018943D26Medicare PIN