Lisa L Edgerly, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070018633 Issued in IL

Practice address

4730 Dempster St
Skokie, IL 60076-2045

Phone

(224) 534-2280

Fax

(847) 674-7201

NPI assigned

Jun 28, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Lisa Hua Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463097600000",
    "number": "1841586807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223",
            "fax_number": "630-759-3251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4730 DEMPSTER ST",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600762045",
            "telephone_number": "224-534-2280",
            "fax_number": "847-674-7201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDGERLY",
        "first_name": "LISA",
        "middle_name": "L",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-28",
        "last_updated": "2016-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070018633",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "HUA",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Mallia Eihentale, DNP, FNP-BC, DCNP

• Physical Therapist in Skokie, IL
• Providers in Skokie, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.