Provider Demographics
NPI:1477975589
Name:BIRD-HOLLANDER, LISA (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:BIRD-HOLLANDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5508 CAMINITO CONSUELO
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7217
Mailing Address - Country:US
Mailing Address - Phone:805-729-4115
Mailing Address - Fax:
Practice Address - Street 1:5508 CAMINITO CONSUELO
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-7217
Practice Address - Country:US
Practice Address - Phone:805-729-4115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19229225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist