Individual
MARK LISAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3112 E BUTLER AVE, FLAGSTAFF, AZ 86004-0009
(860) 519-7902
(502) 212-8502
Mailing address
3112 E BUTLER AVE, FLAGSTAFF, AZ 86004-0009
(860) 519-7902
(502) 212-8502
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0047313
AZ
Other
Enumeration date
06/15/2026
Last updated
06/15/2026
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