Healthcare Provider Details

I. General information

NPI: 1205255890
Provider Name (Legal Business Name): LISA STEJSKAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2014
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 BEAR PATH LN
HUDSON NH
03051-6402
US

IV. Provider business mailing address

29 BEAR PATH LN
HUDSON NH
03051-6402
US

V. Phone/Fax

Practice location:
  • Phone: 603-459-8034
  • Fax:
Mailing address:
  • Phone: 603-459-8034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8609
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160000921
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number1107
License Number StateNH

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: