Provider Demographics
NPI:1467473959
Name:SCHAEFER, LISA ANN (MSPT)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:SCHAEFER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3119 BROTHERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-2799
Mailing Address - Country:US
Mailing Address - Phone:317-332-9611
Mailing Address - Fax:317-216-0377
Practice Address - Street 1:3119 BROTHERWOOD CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2799
Practice Address - Country:US
Practice Address - Phone:317-332-9611
Practice Address - Fax:317-216-0377
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006753225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist