Provider Demographics
NPI:1154699114
Name:BENDER, LISA S (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:S
Last Name:BENDER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 NORTH ST.
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-2712
Mailing Address - Country:US
Mailing Address - Phone:516-364-5378
Mailing Address - Fax:
Practice Address - Street 1:72 FARMEDGE RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-5202
Practice Address - Country:US
Practice Address - Phone:516-827-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006924-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist