Provider Demographics
NPI:1962575118
Name:CHINN, LISA LAI (PTA)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LAI
Last Name:CHINN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1363 STONE GATE ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-4325
Mailing Address - Country:US
Mailing Address - Phone:323-261-0863
Mailing Address - Fax:
Practice Address - Street 1:55 S RAYMOND AVE
Practice Address - Street 2:STE 100
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-7100
Practice Address - Country:US
Practice Address - Phone:626-576-0591
Practice Address - Fax:626-576-5890
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT3699225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant