Provider Demographics
NPI:1194004549
Name:STABE, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:STABE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8015 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:FERN CREEK
Mailing Address - State:KY
Mailing Address - Zip Code:40291-3439
Mailing Address - Country:US
Mailing Address - Phone:502-239-3993
Mailing Address - Fax:502-239-3939
Practice Address - Street 1:8015 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:FERN CREEK
Practice Address - State:KY
Practice Address - Zip Code:40291-3439
Practice Address - Country:US
Practice Address - Phone:502-239-3993
Practice Address - Fax:502-239-3939
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2365225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist