Provider Demographics
NPI:1427580984
Name:BOWARD, LISA (LPTA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BOWARD
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 OFFUTT SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:WV
Mailing Address - Zip Code:26704-7279
Mailing Address - Country:US
Mailing Address - Phone:304-268-7611
Mailing Address - Fax:
Practice Address - Street 1:407 OFFUTT SCHOOL ROAD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:WV
Practice Address - Zip Code:26704
Practice Address - Country:US
Practice Address - Phone:304-268-7611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVPTA 001705225200000X
VA2306604354225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant