Provider Demographics
NPI:1083757819
Name:DRAPER, LISA K (ATC,MED)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:K
Last Name:DRAPER
Suffix:
Gender:F
Credentials:ATC,MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6224 SHERMANS VALLEY RD.
Mailing Address - Street 2:
Mailing Address - City:LOYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17047
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:769 SALEM BLVD
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603-6828
Practice Address - Country:US
Practice Address - Phone:570-542-1488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART002046A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer