Provider Demographics
NPI:1447977657
Name:SHOOK, LISA DIANE (PT)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:DIANE
Last Name:SHOOK
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 1:70 E BEAU ST STE 100
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4726
Mailing Address - Country:US
Mailing Address - Phone:724-222-2074
Mailing Address - Fax:724-222-2089
Practice Address - Street 1:70 E BEAU ST STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4726
Practice Address - Country:US
Practice Address - Phone:724-222-2074
Practice Address - Fax:724-222-2089
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT007409L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist