| 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 |