Provider Demographics
NPI:1417591751
Name:MCNEIL, LISA (LMT, CFSS)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:LMT, CFSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MORELAND BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-2425
Mailing Address - Country:US
Mailing Address - Phone:262-373-8765
Mailing Address - Fax:
Practice Address - Street 1:400 W MORELAND BLVD STE A
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-2425
Practice Address - Country:US
Practice Address - Phone:262-373-8765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-30
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
10918-146225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty