Provider Demographics
NPI:1619174976
Name:SLOYAN, LISA ELAINE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:LISA
Middle Name:ELAINE
Last Name:SLOYAN
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 1:5735 BETHEL CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320-9520
Mailing Address - Country:US
Mailing Address - Phone:270-298-9324
Mailing Address - Fax:
Practice Address - Street 1:313 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:FORDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42343
Practice Address - Country:US
Practice Address - Phone:270-276-3603
Practice Address - Fax:270-276-3609
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA02170225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant