Provider Demographics
NPI:1194092171
Name:PICCOLO, LISA (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:PICCOLO
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 1:319 BROADWAY
Mailing Address - Street 2:ULSTER BOCES ALTERNATIVE EDUCATION
Mailing Address - City:PORT EWEN
Mailing Address - State:NY
Mailing Address - Zip Code:12466
Mailing Address - Country:US
Mailing Address - Phone:845-339-8707
Mailing Address - Fax:
Practice Address - Street 1:319 BROADWAY
Practice Address - Street 2:ULSTER BOCES ALTERNATIVE EDUCATION
Practice Address - City:PORT EWEN
Practice Address - State:NY
Practice Address - Zip Code:12466
Practice Address - Country:US
Practice Address - Phone:845-339-8707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015113-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist