# ANDREW LISITSKY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1104887587
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225100000X | Physical Therapist | 023017 | NY | — |
| 225100000X | Physical Therapist | 65461 | OR | Yes |
| 225100000X | Physical Therapist | PT00008783 | WA | — |

## Other

- **Enumeration date:** 03/28/2006
- **Last updated:** 12/04/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0219769 | L&I | WA |
| 01 | — | 5479LI | REGENCE | WA |
| 01 | — | 7587LI | REGENCE | WA |
| 01 | — | 7588LI | REGENCE | WA |