Provider Demographics
NPI:1407205438
Name:LYSOBEY, MARGARET MARY (PT)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:LYSOBEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:MARY
Other - Last Name:MCGERVEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9503 VISTA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-2314
Mailing Address - Country:US
Mailing Address - Phone:440-237-2806
Mailing Address - Fax:
Practice Address - Street 1:9503 VISTA DR
Practice Address - Street 2:
Practice Address - City:NORTH ROYALTON
Practice Address - State:OH
Practice Address - Zip Code:44133-2314
Practice Address - Country:US
Practice Address - Phone:440-237-2806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH004104225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist