Basic Information
| Provider Information | |||||||||
| NPI: | 1073951638 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DREW | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4205 SAN FELIPE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951351503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082381552 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5600 MOWRY SCHOOL RD | ||||||||
| Address2: | STE 305 | ||||||||
| City: | NEWARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945605371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5106519258 | ||||||||
| FaxNumber: | 5106519258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2013 | ||||||||
| LastUpdateDate: | 10/26/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40107 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.