Healthcare Provider Details

I. General information

NPI: 1497873152
Provider Name (Legal Business Name): LISA A CORSICA M.S., P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S CALUMET RD
CHESTERTON IN
46304-3285
US

IV. Provider business mailing address

201 EVANS AVE
VALPARAISO IN
46383-3508
US

V. Phone/Fax

Practice location:
  • Phone: 219-983-9675
  • Fax:
Mailing address:
  • Phone: 219-508-2060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05002889A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: