Provider Demographics
NPI:1043535537
Name:WEBSTER, LISA MARIE (PT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:BOGARDUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7571 STATE ROUTE 54
Mailing Address - Street 2:IRA DAVENPORT MEM.HOSPITAL, REHAB SERVICES DEPARTMENT
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-9504
Mailing Address - Country:US
Mailing Address - Phone:607-776-8880
Mailing Address - Fax:607-776-8635
Practice Address - Street 1:7571 STATE ROUTE 54
Practice Address - Street 2:IRA DAVENPORT MEM.HOSPITAL, REHAB SERVICES DEPARTMENT
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-9504
Practice Address - Country:US
Practice Address - Phone:607-776-8880
Practice Address - Fax:607-776-8635
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008887-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist