Provider Demographics
NPI:1538481551
Name:LISK, KARYN PARKER (MT)
Entity Type:Individual
Prefix:
First Name:KARYN
Middle Name:PARKER
Last Name:LISK
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 AMBERLEIGH WAY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1870
Mailing Address - Country:US
Mailing Address - Phone:404-271-1297
Mailing Address - Fax:
Practice Address - Street 1:7230 AMBERLEIGH WAY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-1870
Practice Address - Country:US
Practice Address - Phone:404-271-1297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT004776225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist