Provider Demographics
NPI:1609012467
Name:NAIL, LISA D (PTA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:NAIL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-5011
Mailing Address - Country:US
Mailing Address - Phone:931-456-1818
Mailing Address - Fax:931-456-4458
Practice Address - Street 1:707 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-5011
Practice Address - Country:US
Practice Address - Phone:931-456-1818
Practice Address - Fax:931-456-4458
Is Sole Proprietor?:No
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPTA0000003688225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant