Provider Demographics
NPI:1659521037
Name:ROUNTREE, LISA BETH (PT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:BETH
Last Name:ROUNTREE
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 1:838 COUNTY ROAD 925 E
Mailing Address - Street 2:
Mailing Address - City:NORRIS CITY
Mailing Address - State:IL
Mailing Address - Zip Code:62869-3219
Mailing Address - Country:US
Mailing Address - Phone:618-265-9166
Mailing Address - Fax:
Practice Address - Street 1:838 COUNTY ROAD 925 E
Practice Address - Street 2:
Practice Address - City:NORRIS CITY
Practice Address - State:IL
Practice Address - Zip Code:62869-3219
Practice Address - Country:US
Practice Address - Phone:618-265-9166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-23
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007129225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist