Provider Demographics
NPI:1376689950
Name:ROTUNDA, LISA ANNE (DC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:ROTUNDA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5940 BAUM BLVD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3845
Mailing Address - Country:US
Mailing Address - Phone:412-361-8033
Mailing Address - Fax:412-361-5715
Practice Address - Street 1:5940 BAUM BLVD
Practice Address - Street 2:SUITE 7
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3845
Practice Address - Country:US
Practice Address - Phone:412-361-8033
Practice Address - Fax:412-361-5715
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC003494L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA165015OtherBLUE SHIELD
PA201977OtherUPIN C HEALTH PLAN
350039280OtherRR TRAVELERS MEDICARE
PA201977OtherUPIN C HEALTH PLAN
R0165015Medicare ID - Type Unspecified