Provider Demographics
NPI:1396000766
Name:WHYTE, LISA (PT ASSISTANT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WHYTE
Suffix:
Gender:F
Credentials:PT ASSISTANT
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:J
Other - Last Name:GILLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:346 COUNTY ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:CHATEAUGAY
Mailing Address - State:NY
Mailing Address - Zip Code:12920-3402
Mailing Address - Country:US
Mailing Address - Phone:518-497-0306
Mailing Address - Fax:
Practice Address - Street 1:346 COUNTY ROUTE 52
Practice Address - Street 2:
Practice Address - City:CHATEAUGAY
Practice Address - State:NY
Practice Address - Zip Code:12920-3402
Practice Address - Country:US
Practice Address - Phone:518-497-0306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY312064164W00000X
NY001992225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No164W00000XNursing Service ProvidersLicensed Practical Nurse