Provider Demographics
NPI:1699059121
Name:CAMPISI, LISA A (DPT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:CAMPISI
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 1:415 CROSSWAYS PARK DR STE E
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2055
Mailing Address - Country:US
Mailing Address - Phone:516-551-3826
Mailing Address - Fax:
Practice Address - Street 1:415 CROSSWAYS PARK DR STE E
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2055
Practice Address - Country:US
Practice Address - Phone:516-838-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034279-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist