Provider Demographics
NPI:1467867879
Name:BROSE, LISA JEAN (ATC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JEAN
Last Name:BROSE
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 CICERO DR
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-6517
Mailing Address - Country:US
Mailing Address - Phone:724-861-8440
Mailing Address - Fax:
Practice Address - Street 1:4345 ROUTE 136
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6411
Practice Address - Country:US
Practice Address - Phone:724-850-2607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART000805A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist