Provider Demographics
NPI:1609824390
Name:SCHAEFER, LISA (PT)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:SCHAEFER
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:PO DRAWER 2109
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72811
Mailing Address - Country:US
Mailing Address - Phone:479-967-2322
Mailing Address - Fax:479-967-2876
Practice Address - Street 1:272 SCHOOL AVE
Practice Address - Street 2:
Practice Address - City:WEST FORK
Practice Address - State:AR
Practice Address - Zip Code:72774-3124
Practice Address - Country:US
Practice Address - Phone:479-839-3349
Practice Address - Fax:479-839-3752
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2749225100000X
MSPT5394225100000X
ARPT2749225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR662725OtherHEALTHLINK
AR154417721Medicaid
AR445934001OtherPALMETTO GI DME
AR5X979OtherBLUE CROSS BLUE SHIELD
AR71085780150OtherQUALCHOICE
AR154417721Medicaid