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General NPI Number Information
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NPI Number | 1912027160
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Entity Type | Individual
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Provider Name | LISA JOSUPAIT MPT
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Gender | Female
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 10/01/2019
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Provider Practice Location Address
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Address Line | 7 RALPH JUDD COURT
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City | AURORA
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State | IL
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Zip | 60506
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Country | US
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Telephone | 630-466-2083
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Fax |
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Provider Business Mailing Address
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Address Line | 1377 MOTOR PKWY STE 307
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City | ISLANDIA
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State | NY
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Zip | 11749-5258
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Country | US
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Telephone | 631-580-5200
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Fax | 631-580-5222
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 070012467
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License Number State | IL
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