Provider Demographics
NPI:1366485773
Name:CIRILLO, LISA WARD (PT, CERT MDT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:WARD
Last Name:CIRILLO
Suffix:
Gender:F
Credentials:PT, CERT MDT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANNE
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:659 S SALISBURY BLVD STE 1B
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5458
Mailing Address - Country:US
Mailing Address - Phone:410-831-3226
Mailing Address - Fax:410-572-4041
Practice Address - Street 1:20684 JOHN J WILLIAMS HWY STE 2
Practice Address - Street 2:
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958-4393
Practice Address - Country:US
Practice Address - Phone:302-945-0200
Practice Address - Fax:302-945-6959
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0000575225100000X
225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE022693Y0XMedicare PIN