Provider Demographics
NPI:1871622530
Name:GROSSFARBER, LISA ELLEN (PT)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ELLEN
Last Name:GROSSFARBER
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 1:10406 NW 5TH CT
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1611
Mailing Address - Country:US
Mailing Address - Phone:954-226-9665
Mailing Address - Fax:
Practice Address - Street 1:10406 NW 5TH CT
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1611
Practice Address - Country:US
Practice Address - Phone:954-226-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22940225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist