| NPI | 1851811061 |
|---|---|
| Former Name | LISA RENEE ANDERSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: GA PTA001902) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: GA PTA001902) |
| Enumeration Date | 2017-06-20 |
| Last Update Date | 2023-12-21 |