Provider Demographics
NPI:1932208337
Name:FRIEDMAN, LISA ANDREA (PT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANDREA
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3045 HIGHWAY 101 N STE 11-142
Mailing Address - Street 2:
Mailing Address - City:GEARHART
Mailing Address - State:OR
Mailing Address - Zip Code:97138-4354
Mailing Address - Country:US
Mailing Address - Phone:808-346-8808
Mailing Address - Fax:
Practice Address - Street 1:3045 HIGHWAY 101 N STE 11-142
Practice Address - Street 2:
Practice Address - City:GEARHART
Practice Address - State:OR
Practice Address - Zip Code:97138-4354
Practice Address - Country:US
Practice Address - Phone:808-346-8808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3045225100000X
HI3604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist