Provider Demographics
NPI:1083784987
Name:LOMBARD, LISA A (MPT DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:LOMBARD
Suffix:
Gender:F
Credentials:MPT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6050 AIRLINE RD
Mailing Address - Street 2:STE. 106
Mailing Address - City:ARLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38002-4895
Mailing Address - Country:US
Mailing Address - Phone:901-867-8989
Mailing Address - Fax:901-867-8757
Practice Address - Street 1:6050 AIRLINE RD
Practice Address - Street 2:STE. 106
Practice Address - City:ARLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38002-4895
Practice Address - Country:US
Practice Address - Phone:901-867-8989
Practice Address - Fax:901-867-8757
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000006452225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3645941Medicare ID - Type Unspecified