Provider Demographics
NPI:1457184202
Name:TANGUAY, LISA KAY (DPT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAY
Last Name:TANGUAY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 EDWIN MILLER BLVD
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25404-5717
Mailing Address - Country:US
Mailing Address - Phone:304-728-1750
Mailing Address - Fax:
Practice Address - Street 1:1314 EDWIN MILLER BLVD
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-5717
Practice Address - Country:US
Practice Address - Phone:304-728-1750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV004798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist