| Doctor Name: | MS. LISA L TYLICKI |
| NPI Number: | 1982700308 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PT |
| License Number: | 006703 |
| Business Practice Address: | 110 W Herrick Ave Suite B Wellington, OH - 440901240 |
| Business Phone Number: | 4406470107 |
| Business Fax Number: | 4406471030 |
| Mailing Address: | 148 Mallard Creek Run, LAGRANGE |
| State: | OH |
| Postal Code: | 440509804 |
| Phone Number: | 4194477203 |
| Fax Number: | 4194475577 |
| NPI Enumeration Date: | 09/15/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 006703 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |