Provider Demographics
NPI:1205006830
Name:EDELMAN, LISA M (PTA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:EDELMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 TUTTLE CREEK BLVD LOT 7
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-7120
Mailing Address - Country:US
Mailing Address - Phone:785-770-7512
Mailing Address - Fax:
Practice Address - Street 1:2121 MEADOWLARK RD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-4556
Practice Address - Country:US
Practice Address - Phone:785-770-7512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1401834225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant