Provider Demographics
NPI:1871970053
Name:PRISCO, LISA (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PRISCO
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 1:33 CHADWICK DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-5828
Mailing Address - Country:US
Mailing Address - Phone:302-698-4256
Mailing Address - Fax:
Practice Address - Street 1:810 NEW BURTON RD
Practice Address - Street 2:STE 2
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-5488
Practice Address - Country:US
Practice Address - Phone:302-724-5593
Practice Address - Fax:302-724-5595
Is Sole Proprietor?:No
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0000317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist