Provider Demographics
NPI:1457656365
Name:ROEHL, LISA J (DPT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:ROEHL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8811 WARREN H. ABERNATHY HWY.
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-1228
Mailing Address - Country:US
Mailing Address - Phone:864-574-7282
Mailing Address - Fax:864-574-7664
Practice Address - Street 1:28 JIMMY DOOLITTLE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-2622
Practice Address - Country:US
Practice Address - Phone:864-679-8606
Practice Address - Fax:864-679-8608
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC61242251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics