Basic Information
| Provider Information | |||||||||
| NPI: | 1821313578 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LISKEY | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | HOBERG | ||||||||
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| Credential: | PT | ||||||||
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| OtherLastName: | HOBERG | ||||||||
| OtherFirstName: | EMILY | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 790 REMINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604404909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302962223 | ||||||||
| FaxNumber: | 6307599510 | ||||||||
| Practice Location | |||||||||
| Address1: | 6985 COAL CREEK PKWY SE | ||||||||
| Address2: | |||||||||
| City: | NEWCASTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980593136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253780500 | ||||||||
| FaxNumber: | 4253788168 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2010 | ||||||||
| LastUpdateDate: | 07/07/2015 | ||||||||
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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 | J10002582 | DE | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT 60532233 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.