Basic Information
| Provider Information | |||||||||
| NPI: | 1760599245 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOYT | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | ROSE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4065 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278362065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522159119 | ||||||||
| FaxNumber: | 2522159121 | ||||||||
| Practice Location | |||||||||
| Address1: | 2430 CHARLES BLVD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278585924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522159119 | ||||||||
| FaxNumber: | 2522159121 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 11/06/2013 | ||||||||
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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 | 2004 | NC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 079EJ | 01 | NC | BLUECROSS BLUESHIELD | OTHER | 56162 | 01 | NC | MEDCOST | OTHER |