Provider Demographics
NPI:1609029024
Name:FIANDER, LISA M
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:FIANDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11733 STANNARY PL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-7814
Mailing Address - Country:US
Mailing Address - Phone:919-665-9084
Mailing Address - Fax:
Practice Address - Street 1:6105 EAGLESFIELD DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-7860
Practice Address - Country:US
Practice Address - Phone:919-900-7102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-29
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist