Provider Demographics
NPI:1689077711
Name:PARKER, LISA RAE (AT/ATC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RAE
Last Name:PARKER
Suffix:
Gender:F
Credentials:AT/ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 S TRIMBLE RD
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3418
Mailing Address - Country:US
Mailing Address - Phone:419-756-8899
Mailing Address - Fax:419-520-3561
Practice Address - Street 1:536 S TRIMBLE RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3418
Practice Address - Country:US
Practice Address - Phone:419-756-8899
Practice Address - Fax:419-520-3561
Is Sole Proprietor?:No
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT-11792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer