NPI | 1720057110 |
---|---|
Other Name | LISA RENEE JESBERG |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305004592) |
Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: VA 2305004592) |
2255A2300X Specialist/Technologist, Athletic Trainer (Licence: VA 0126000619) | |
Enumeration Date | 2006-03-16 |
Last Update Date | 2016-05-25 |