Provider Demographics
NPI:1154532281
Name:MARSHALL, LISA DIANE (PT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DIANE
Last Name:MARSHALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2451 FAIRCHILD CIR NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-6630
Mailing Address - Country:US
Mailing Address - Phone:330-499-7174
Mailing Address - Fax:
Practice Address - Street 1:2821 WOODLAWN AVE NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-1423
Practice Address - Country:US
Practice Address - Phone:330-479-4805
Practice Address - Fax:330-479-4803
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT-007852225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist