Individual
LISA A LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1282 MAIN ST, FAIRFAX, VT 05454-9534
(802) 849-9308
Mailing address
1889 VT ROUTE 128, WESTFORD, VT 05494-9611
(802) 881-6013
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0400067001
VT
Other
Enumeration date
09/15/2010
Last updated
09/15/2010
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