Provider Demographics
NPI:1023133964
Name:POORMON, LISA M (PT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:POORMON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10815 W MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-5007
Mailing Address - Country:US
Mailing Address - Phone:623-433-0199
Mailing Address - Fax:623-433-0198
Practice Address - Street 1:10815 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5007
Practice Address - Country:US
Practice Address - Phone:623-433-0199
Practice Address - Fax:623-433-0198
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ7498208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation